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In Measuring Trust: Where are we and where do we need to go? Drs. Platt and Taylor set out to address three issues which have fueled the propagation of trust measures:

  1. The lack of conceptual clarity across measures
  2. A lack of consensus around a single measure or set of measures
  3. Trust may operate differently depending on who is trusting whom, and what the context is

The intended readers for this guide are (1) health system leaders, organizational leaders and others interested in adopting measures at their institutions, (2) health services researchers who may not be focused on the issue of trust as a primary area of expertise, but see it as an important variable or outcome of interest in their work, and (3) those interested in assessing measures to support a convergence of methods and/or processes for choosing how, when, and what aspects of trust are to be measured.  

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Publicly Available
Assessing Trust in Health Care: A Compendium of Trust Measures
By
Platt JE, Taylor LA
Source:
AcademyHealth

Recruiting and retaining quality staff remains the top healthcare issue. Last year, hospitals were able to recapture 5.65% of the talent lost during the “Great Resignation”, essentially adding 975,000 employees back to the rolls. Of this, 142,375 RNs returned which represents a 4.17% RN add rate. This slower rate begs the question, why are nurses hesitant to return? Although welcome news, the labor gap remains prevalent and hospital turnover continues to be elevated. Nationally, the hospital turnover rate stands at 22.7%, a 3.2% decrease from 2021, and RN turnover is recorded at 22.5%, a 4.6% decrease. Registered Nurses working in surgical services, pediatrics and women’s health recorded the lowest turnover rate, while nurses working in telemetry, step down and medical/surgical services experienced the highest. The cost of turnover can have a profound impact on diminishing hospital margins and needs to be managed. According to the survey, the average cost of turnover for a bedside RN is $52,350, a 13.5% increase, resulting in the average hospital losing between $6.6m – $10.5m. Each percent change in RN turnover will cost/save the average hospital an additional $380,600/yr. The RN vacancy rate remains critical and is 15.7% nationally. While 1.3% lower than last year, over seventy-five percent (75.4%) reported a vacancy rate in excess of ten percent. The RNRecruitment Difficulty Index jumped an extra eight (8) days to an average of 95 days. In essence, it takes over 3 months to recruit an experienced RN, with med/surg presenting the greatest challenge. Feeling the financial stress, hospitals are looking to decrease reliance on supplemental staffing. The greatest potential to offset margin compression is in the top budget line item (labor expense). Every RN hired saves $157,000. An NSI contract to replace 20 travel nurses could save your institution $3,140,000.

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Publicly Available
2023 NSI National Health Care Retention & RN Staffing Report
By
NSI Nursing Solutions, Inc
Source:
NSI Nursing Solutions, Inc

BACKGROUND AND PURPOSE: To better understand the effects of an intervention, Mindfulness for Healthcare Professional (MIHP), and how it may improve healthcare professional student (HCP) functioning, a constructivist grounded theory exploration was conducted. MATERIALS AND METHODS: Ten participants with the lowest or highest changes on quantitative measures of burnout and perceived stress at the end of MIHP were interviewed at a long-term follow-up. A theoretical framework was developed from the resultant themes to describe the mechanisms by which MIHP had effects on work-relevant functioning. RESULTS: Three overarching themes emerged as mechanisms of change both from their presence in those participants reporting an improvement in stress and their missingness from those participants who reported no change: developing a mindfulness practice, integrating practice into daily life, and enhanced awareness. These mechanisms led to optimized work-relevant functioning: 1) emotional competencies, including nonjudgement, emotion regulation, and burnout prevention; and 2) patient-centered care, including improved listening, patience, and efficiency at work. CONCLUSION: The resultant framework is discussed in the context of previous literature on MIHP and mindfulness theory more broadly. Implications for future disseminations of MIHP encourage the use of group interventions with emphasis on developing at-home practice and informal mindfulness integrated into daily work.

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Publicly Available
A Constructivist Grounded Theory Exploration of Mindfulness for Healthcare Professional Students
By
Braun, Sarah Ellen; Mladen, Samantha; Crawford, MaryKate; Edwards, Sarah; Kinser, Patricia
Source:
Complementary Therapies in Clinical Practice

PURPOSE: The objective of this study was to investigate the effect of work stress on job burnout and quality of life and the effect of moderating group factors (transformational leadership and group member interactions) on the relationship between work stress, job burnout, and quality of life. This study takes front-line border police as the research object, adopts a cross-level perspective, and takes work stress as a key factor affecting work efficiency and health indicators. METHODS: It collected data through questionnaires, with questionnaires for each research variable adapted from existing research scales, such as multifactor leadership questionnaire developed by Bass and Avolio. A total of 361 questionnaires were filled out and collected in this study, including 315 male participants and 46 female participants. The average age of the participants was 39.52. Hierarchical linear modeling (HLM) was used to test the hypotheses. RESULTS: First, it was found that work stress has a significant impact on job burnout and quality of life. Secondly, leadership style and group member interactions have a direct, cross-level effect on work stress. Third, it found that leadership style and group member interactions have an indirect, cross-level effect on the relationship between work stress and job burnout. However, these are not indicative of quality of life. The results of this study highlight the particular impact of the nature of police work on the quality of life, and further enhance the value of this study. CONCLUSION: The two major contributions of this study are: 1) it shows the original characteristics of the organizational environment and the social context of Taiwan’s border police and, 2) in terms of the research implication, it is necessary to re-examine the crosslevel impact of group factors on individual work stress.

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Publicly Available
A Cross-Level Study of the Consequences of Work Stress in Police Officers: Using Transformational Leadership and Group Member Interactions as an Example
By
Cho, Cheng-Chung
Source:
Psychology Research and Behavior Management

BACKGROUND: Prior to the novel coronavirus (COVID-19) pandemic, nurses died by suicide more frequently than the general population. Antecedents prior to death include known job problems, such as disciplinary action; diversion of medications; inability to work due to chronic pain; and physical and mental illness. AIM: The aim of this study was to explore the suicide experience of nurses who died with known job-related problems during the early phase of the COVID-19 pandemic compared to what has been previously described. METHOD: Deductive reflexive thematic analysis was used to analyze narratives of nurses with known job problems who died by suicide from the Centers for Disease Control and Prevention's National Violent Death Reporting System. RESULTS: Forty-three nurses with known job-related problems completed suicide between March and December 2020. Factors associated with death were similar to previous findings with notable exceptions, increased prevalence of suicidal ideation and post-traumatic stress prior to the event. Pandemic-specific issues were noted including reduction in hours, fear of disease transmission, civil unrest, and grief-related trauma. LINKING EVIDENCE TO ACTION: Suicide prevention programs need to address both institutional and individual factors associated with nurse suicide. As previously recommended, transitions into retirement and job loss are vulnerable times warranting psychological support. Further, strategies to reduce the impact of stressors and increase support for nurses are needed at the organizational level. A systems level approach to hardwire coping strategies is indicated pre-licensure and throughout nurses' careers. A new focus on how to process personal and professional grief is warranted. Resources are needed for nurses traumatized by life (rape, childhood trauma) or work-related experiences.

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Publicly Available
A Deductive Thematic Analysis of Nurses with Job-Related Problems who Completed Suicide during the Early COVID-19 Pandemic: A Preliminary Report
By
James, Kristina E.; Agarwal, Suzanne; Armenion, Karen L.; Clapp, Chris; Barnes, Arianna; Ye, Gordon Y.; Zisook, Sidney; Davidson, Judy E.
Source:
Worldviews on Evidence-Based Nursing

BACKGROUND: Violence and aggression is commonly encountered in nursing worldwide and is an increasing concern, although it is largely underreported by staff. Violence and aggression can take many forms, from verbal and physical abuse to sexual assault. This study aims to define agitation, violence, and aggression and to explore the prevalence of violence and aggression among neuroscience patients. This review also examines why violence and aggression occurs for neuroscience patients and to determine the effects on the patients, the environment, and the nursing staff. METHODS: A review of articles was conducted using CINAHL, PubMed, the Cochrane Database, and Google Scholar between 2012 and 2022. DISCUSSION: Agitation can escalate to violence and aggression. The reasons a neuroscience patient may become agitated are multifactorial. An injury to the brain may not cause agitation; however, the effect on the frontal lobe, hypothalamus, and hippocampus may cause a lack of self-control, impulsivity, an inability to control emotions, and an uncontrolled release of hormones, leading to a heightened sympathetic response. The effects of violence and aggression can be detrimental to the patient and include isolation, increased sedation, reduced observations, and even death. The effects on the nurse are profound including a decline in productivity at work, an increased risk of drug errors, and posttraumatic stress disorder or burnout as longer-term consequences. CONCLUSION: Violence and aggression is commonly experienced within neuroscience nursing, and the contributing factors are multifactorial. The effects for the patients and staff can be profound, and this is why prevention of agitation is fundamental to ensure the safety and retention of nursing staff.

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Publicly Available
A Literature Review: Violence and Aggression in Neuroscience Nursing
By
Woon, Caroline
Source:
Journal of Neuroscience Nursing

OBJECTIVE: This study aimed to longitudinally examine the prevalence and correlates of burnout in frontline healthcare workers (FHCWs) during COVID-19 in New York City. METHODS: A prospective cohort study of 786 FHCWs at Mount Sinai Hospital was conducted during the initial COVID surge in April to May 2020 (T1) and November 2020 to January 2021 (T2) to assess factors impacting burnout. RESULTS: Burnout increased from 38.9% to 44.8% (P = 0.002); 222 FHCWs (28.3%) had persistent burnout, 82 (10.5%) had early burnout, and 129 (16.5%) had delayed burnout. Relative to FHCWs with no burnout (n = 350; 44.7%), those with persistent burnout reported more prepandemic burnout (relative risk [RR], 6.67), less value by supervisors (RR, 1.79), and lower optimism (RR, 0.82), whereas FHCWs with delayed burnout reported more prepandemic burnout (RR, 1.75) and caring for patients who died (RR, 3.12). CONCLUSION: FHCW burnout may be mitigated through increasing their sense of value, support, and optimism; treating mental health symptoms; and counseling regarding workplace distress.

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Publicly Available
A Longitudinal Cohort Study of Factors Impacting Healthcare Worker Burnout in New York City during the COVID-19 Pandemic
By
Peccoralo, Lauren A; Pietrzak, Robert H; Tong, Michelle; Kaplan, Sabrina; Feingold, Jordyn H; Feder, Adriana; Chan, Chi; Verity, Jaclyn; Charney, Dennis; Ripp, Jonathan
Source:
Journal of occupational and environmental medicine

It is well-established that different leadership styles are associated with followers' mental health. However, little is known about the relative strength of the relationship of different leadership styles with followers' mental health. So far, there is no meta-analysis comparing the incremental contribution of different leadership styles to mental health and studying potentially problematic construct proliferation. We included studies that compared at least two leadership styles in view of their relationships with followers' mental health and directly estimated the relative contribution of seven leadership styles (i.e., transformational, transactional, laissez-faire, task-oriented, relationship-oriented, and destructive leadership, as well as leader-member exchange) to followers' mental health. Using meta-analytical regression models, we compared the strength of the relationships between these leadership styles and followers' overall mental health as well as positive (well-being and psychological functioning) and negative aspects of their mental health (affective symptoms, stress, and health complaints). Fifty-three studies with 217 effect sizes comprising 93,470 participants met the inclusion criteria. Transformational and destructive leadership were the strongest predictors of overall and negative aspects of mental health among followers. In contrast, the strongest predictors of positive mental health outcomes among followers were relations-oriented and task-oriented leadership, followed by transformational leadership. In sum, our results suggest that various leadership styles make unique contributions to explaining followers' mental health and thus construct proliferation mostly does not pose a major problem when predicting relevant outcomes in this domain of leadership research. Our results are relevant for leadership development programs and for future organizational leadership models.

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A Meta-Analysis of the Relative Contribution of Leadership Styles to Followers' Mental Health
By
Montano, Diego; Schleu, Joyce Elena; Hüffmeier, Joachim
Source:
Journal of Leadership & Organizational Studies

This mixed-methods pilot study explored the psychological and emotional experiences of chaplains and the feasibility, acceptability, and impact of workshops designed to support chaplain well-being. After the workshops, scores on a measure of self-compassion increased, while secondary traumatic stress and burnout scores decreased. Qualitative data reflected the range of experiences of chaplaincy as well as the benefits of the workshops. This pilot study supports further exploration of organizational interventions to promote chaplain well-being.

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A Mixed-Methods Pilot Study of a Well-Being Intervention for Healthcare Chaplains
By
Harris, Stephanie L.; Sawyer, Amanda T.; Tao, Hong; Bailey, Amanda K.
Source:
The Journal of Pastoral Care & Counseling: JPCC

Few career paths are as mentally, physically, and emotionally exhausting as a career in healthcare. Due to the nature of the job responsibilities, healthcare professionals often sacrifice their own wellbeing for the sake of their patients. The COVID-19 pandemic has asked an even greater sacrifice from healthcare professionals and continues today with little end in sight. The majority of healthcare workers report that stress has a negative impact on their work, which can ultimately manifest in poor patient outcomes and decreased work satisfaction. As stewards of wellbeing, it is imperative that healthcare professionals prioritize self-care and find their own individualized way(s) to manage stress. Building resilience, which is the ability to adapt to traumatic or adverse events in a positive manner, can help decrease anxiety, depression, and burnout. Resilience also helps healthcare professionals re-establish meaning in both their professional and personal lives, and has been proven to improve patient safety and job satisfaction. Complementary and integrative modalities treat the whole person by focusing on the physical, emotional, social, economic, and spiritual needs of the individual. Techniques such as meditation, progressive muscle relaxation, 4-7-8 breathwork, acupressure, aromatherapy, and Jin Shin Jyutsu have been used with great success in the workplace setting to help build resilience. Such techniques offer options for stress reduction and can decrease feelings of work-related burnout. These techniques can be used in real time at the moment of a stressful event. They may also help reduce stress when used prior to, or at the end of a workday. Consistent practice can reduce the feelings of stress that contribute to compassion fatigue and burnout. These integrative health modalities do not require any additional tools or extensive training. They are easy to learn and perform, and can be easily incorporated into a daily practice to encourage stress reduction and promote wellbeing.

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Publicly Available
A Moment of Peace: Utilizing Practical on the Job Relaxation and Meditation Techniques to Improve Feelings of Stress and Burnout Among Healthcare Professionals
By
Wood, Kristine; Carini, Carolanne
Source:
Journal of Interprofessional Education & Practice

OBJECTIVE: The objective of this study was to characterize work engagement and burnout as well as potential demographic factors associated with each student and faculty member at 2 pharmacy programs in the US. METHODS: A survey including the Utrecht Work Engagement Scale-9 (UWES-9) and a single-item burnout measure was conducted from April to May 2020. Demographic data including age range, gender, and other characteristics were also collected. Mean UWES-9 scores, scoring category results, and the proportion of the cohorts reporting symptoms of burnout were reported. Point biserial correlation was used to compare the relationship between UWES-9 mean scores and burnout rates. Regression analyses were also performed to assess variables predictive of work engagement and burnout. RESULTS: Students (N = 174) reported a mean UWES-9 score of 3.0 (SD = 1.1), while faculty members (N = 35) reported a mean of 4.5 (SD = 0.7). Over half (58.6%) of the students and 40% of faculty members reported symptoms of burnout. Faculty members demonstrated a strong significant negative correlation between work engagement and burnout (r = −0.35), while students did not (r = 0.04). Regression analyses found no significant demographic factors predictive of UWES-9 scores in students or faculty, while first year students were less likely to report burnout symptoms, and no significant factors for burnout were found in faculty. CONCLUSION: Our study found that work engagement scores and burnout symptoms were inversely correlated in pharmacy faculty members surveyed but lacked correlation in students. Larger, more robust studies should be conducted to further elucidate the relationship between work engagement and burnout.

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Publicly Available
A Multicenter Study Assessing Burnout and Work Engagement in Student Pharmacists and Faculty Members
By
Malcolm, Daniel; Boyle, Jaclyn
Source:
American Journal of Pharmaceutical Education

BACKGROUND: Burnout in pediatric residents is widespread. Certain factors are associated with decreased burnout, such as empathy, self-compassion, mindfulness, and resilience, while perceived stress is associated with increased burnout. Narrative medicine may reduce burnout by its impact on protective and exacerbating factors and can be an active tool to promote wellness. The objective of this pilot study was to evaluate immediate and delayed benefits of a longitudinal narrative medicine intervention for pediatric residents using qualitative and quantitative measures. MATERIALS AND METHODS: We designed a voluntary longitudinal narrative medicine intervention implemented via Zoom teleconferencing software over five months for pediatric residents at Nationwide Children’s Hospital. It consisted of six one-hour long sessions where residents engaged with literature, responded to a writing prompt, and shared their reflections. It was evaluated using open-ended survey questions and established quantitative assessment tools of well-being with validity evidence. Results were compared before the intervention, immediately after, and six months later using one-way ANOVA and multiple linear regression. Qualitative data was analyzed using thematic analysis. RESULTS: Twenty-two (14% of eligible) residents participated in at least one session. After the intervention, the following themes emerged for benefits to resident well-being: the ability to Build Community, have an Outlet for Self-Expression, reap Emotional and Mental Health Benefits, and work on Personal Growth. Benefits were sustained even six months later, which has not been shown previously. While there were significant qualitative findings, between all three time points, there was no change in any quantitative well-being measures. CONCLUSION: Our longitudinal narrative medicine pilot study showed meaningful sustained qualitative benefits, though no quantitative changes, in measured well-being outcomes that have been previously associated with lower resident burnout. While not a panacea, narrative medicine can be a useful strategy for residency programs to improve pediatric resident well-being even after completion of planned interventions.

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Publicly Available
A Narrative Medicine Intervention in Pediatric Residents Led to Sustained Improvements in Resident Well-being
By
Bajaj, Nimisha; Phelan, James; McConnell, Erin E.; Reed, Suzanne M.
Source:
Annals of Medicine

[This is an excerpt.] We were pleased to read the article by Davis et al examining the association between burnout and professional milestone attainment for family medicine resident physicians.1 We were very surprised by the finding that, in their study of over 2500 family medicine residents, Black, Latinx, and Asian family medicine residents experience burnout at lower rates than their White peers. It defies logic that residents who identify as Black, Indigenous, or a Person of Color (BIPOC) experience lower levels of burnout when they are differentially and systematically burdened by experiences of discrimination, microaggressions, and inequitable access to mentorship and structured opportunity and lack of belonging compared to their non-BIPOC colleagues.2- 4 In the discussion, the authors did not have room to explore why burnout trends show the opposite of what we would expect to see. We offer the following insights as to why these findings might be valid, and we would welcome discussion from the authors on this finding. [To read more, click View Resource.]

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Publicly Available
A Peculiar Trend: Family Medicine Residents of Color are Less Burned Out
By
Jackson, Nicole; Wusu, Maria; Washington, Judy; Rodriguez, Jose
Source:
Family Medicine

BACKGROUND: Vaccination is an important component of the public health response to the pandemic, and a large health care system such as UCLA Health must optimize mechanisms to address questions from patients to expedite vaccine acceptance and administration. Local Problem In 2020-2021, COVID-19 vaccines were developed, studied, and approved at unusual speed, leading to both vaccine hesitancy and requests for urgent availability. This required up-to-date responses from physicians to questions through the online patient portal in the UCLA health care system. There was the additional risk of physician burnout due to the large number of questions. INTERVENTION: We developed a physician strike team that enabled accurate and timely dissemination of vaccine information in response to patient queries. The strike team served a dual purpose of answering patient questions quickly with accurate information, and reducing the workload for other physicians. Using a strike team of 10 early career physicians responding to a collection of patient messages, this large community-based health system was able to provide timely, high-quality responses to COVID-19 vaccine-related questions. RESULTS: After the introduction of the physician strike team program in late January 2021 through April 2021, there was a significant reduction in the average number of messages and calls received by covered providers per month compared to the adjusted number of messages and calls they would have received had the pool not existed. The strike team provided a service with high satisfaction scores from both the participating strike team members and the physicians being covered by the strike team. CONCLUSIONS: The success of this small physician strike team to impact inbasket patient messages and calls in our institution suggests that a similar mechanism can be developed to centralize the replies to certain messages, which may reduce the workload and burnout of physicians.

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Publicly Available
A Physician Strike Team to Disseminate Accurate and Timely COVID-19 Vaccination Information and Improve Responses to Patient Questions
By
Chima-Melton, Chidinma; Han, Maria; Naghshineh, Sheila; Chima-Okereke, Chibisi; Samras, Nathan
Source:

RATIONALE AND OBJECTIVES: Few studies have examined what constitutes effective interventions to reduce burnout among radiologists. We compared self-reported burnout among academic medical center radiologists before and after a series of departmental initiatives intended to increase wellbeing and professional satisfaction. MATERIALS AND METHODS: This Institutional Review Board-approved, prospective study took place 2017-2019 in a tertiary academic medical center. In pre- (2017) and post-intervention (2019) periods, we administered the previously-validated Stanford Physician Wellness Survey to faculty in our 11-division radiology department. Faculty rated their burnout level across 8 domains (professional fulfillment, emotional exhaustion, interpersonal disengagement, sleep difficulties, self-compassion, negative work impact on personal relations, organizational/personal values alignment, perceived quality of supervisory leadership). Between the two surveys, departmental initiatives focusing on culture, team building, work-life balance, and personal well-being were implemented (e.g., electronic medical record training, shorter work hours). Pre- and post-survey results were compared, using Whitney-Mann U test to calculate Z scores. RESULTS: Faculty members rated lower professional fulfillment (Z-3.04, p=0.002), higher emotional exhaustion (Z=2.52, p=0.012), increased sleep-related impairment (Z=2.38, p=0.012), and reduced organizational/personal values alignment (Z=-4.10, p<0.0001) between the two surveys. No significant differences were identified associated with interpersonal disengagement (Z=1.82, p=0.069), self-compassion (Z=1.39, p=0.164), negative impact of work on personal relationship (Z=0.89, p=0.372) and perceived supervisory leadership quality (Z=0.07, p=0.942). CONCLUSION: Despite numerous departmental initiatives intended to improve culture, workplace efficiency, work-life balance, and personal wellness, self-reported burnout was unchanged or worsened over time.Physician and employee wellness embedded into institutional culture maybe more effective than departmental improvement initiatives.

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Publicly Available
A Prospective Intervention to Reduce Burnout Among Academic Radiologists
By
Ip, Ivan K.; Giess, Catherine S.; Gupte, Anu; Eappen, Sunil; Healey, Michael J.; Khorasani, Ramin
Source:
Academic Radiology

BACKGROUND: The purpose of this work was to describe the experiences of EMS personnel in responding to drug overdose-related calls and the impact the pandemic has had to help better inform current response and treatment efforts. METHODS: Semi-structured interviews were conducted with 99 EMS personnel across 18 areas throughout the United States that were designated as Early Warning Network sentinel sites by the National Institute on Drug Abuse-funded National Drug Early Warning System. Participants were asked about topics including the potential burdens from the pandemic and the opioid crisis. We coded the interview responses and identifed themes through qualitative analysis. Multiple cycles of descriptive coding, recoding, subcoding, pattern-coding, and thematic coding of responses were conducted. RESULTS: Responses were categorized into the following themes: 1) being over-worked from increased call volume; 2) increased risk for personal harm when responding to patients; 3) compassion fatigue due to long hours and repeat calls for the same people; 4) conflicting perceptions of the utility of naloxone; 5) the need for better treatment options to respond to opioid crisis on top of COVID-19. CONCLUSIONS: The burden of the substance use disorder (SUD) crisis on EMS personnel has been compounded by the COVID-19 pandemic. These reports from EMS personnel throughout the US can help inform policy and procedures to better protect the mental health of EMS personnel and to ensure better care for patients with SUD. These experiences and recommendations may be of use for other countries as substance use and COVID-19 are global health issues.

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Publicly Available
A Qualitative Analysis of Emergency Medical Services Personnel Experiences and Perception Responding to Drug Overdoses in the US during the COVID-19 Pandemic
By
Won, Nae Y.; Palamar, Joseph J.; Mike, Stephen A.; Fitzgerald, Nicole D.; Cottler, Linda B.
Source:
Journal of Health Research

OBJECTIVE: The primary objective of this qualitative study was to describe key themes discussed by student pharmacists and preceptors related to recognizing burnout and maintaining wellbeing during an experiential assignment. METHODS: This qualitative study used directed content analysis to examine themes that emerged from discussions between student pharmacists and preceptors as part of a required lifelong learning interview during Introductory Pharmacy Practice Experiences that took place between August 2019 and May 2020. Iterative axial coding was used to develop and redefine codes systematically until consensus was reached and a final codebook was established. All responses were coded using the consensus categories. RESULTS: From the 228 interviews analyzed, 3 overarching themes emerged: causes of burnout, manifestations or symptoms of burnout, and strategies to manage stress and burnout. Preceptors identified the mechanics of the job and feeling extreme pressure or worry as 2 major causes of burnout, which manifest as physical exhaustion, mental exhaustion, and poor work performance. To manage stress, preceptors reported using personal and work-positive coping strategies. CONCLUSION: The major themes derived from the analysis—causes of burnout, manifestations of burnout, and strategies to manage stress—align with what is already known about health care provider wellbeing. Although it remains unknown if this type of wellness intervention is effective at changing student stress management habits, results indicate that the intervention sparked conversations that could assist students in establishing a baseline of knowledge on the topic and supply students with a toolkit of resiliency strategies.

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A Qualitative Analysis of Student and Preceptor Resiliency Discussions During Introductory Pharmacy Practice Experiences
By
Joseph, Andrea; Mayer, Danielle C.
Source:
American Journal of Pharmaceutical Education

During recent years, police have suffered from job dissatisfaction, exhaustion, stress, and burnout; this issue has led to shortages of sworn police across the country. A high percentage of police officers leave the job in the first 5 years of service. A goal of this study was to discover how police investigators build resiliency to those challenging factors so that the individual can remain resilient despite exposure to adverse incidents and conditions that lead to severe stress and burnout. A generic qualitative method was used so that police investigators could share their lived experiences during their interviews and describe their beliefs, reflections, and opinions about their exposure to adversities on the job, and how they built resilience to those experiences. The target population for this study was police investigators who had more years of experience on the job than the less experienced sworn police members who were reportedly quitting the job from job-related dissatisfaction and burnout. The sample consisted of seven sworn police investigators from a small urban police department in the northeast region of the United States. I conducted semi-structured interviews of the seven participants, recorded the interviews using a Sony digital voice recorder, and used Descript transcription software to transcribe the audio recorded interviews to text. A thematic analysis approach was taken to find repeating patterns to identify five common themes from the collected data. These emerging themes were: (a) alcohol consumption used as a temporary coping strategy; (b) setting emotions aside; (c) family and nonlaw enforcement friends were perceived as not understanding: (d) exercise used as self-care method of effective coping; and (e) talking and venting to fellow law enforcement members as an effective coping method. During the interviews, the participants discussed several critical adverse incidents and conditions that caused stress and hardship for them. Through those shared experiences, I learned from the participants how they coped with those adversities and what helped them build resiliency.

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Publicly Available
A Qualitative Investigation of Police Investigators and Resiliency
By
Milloff, Timothy
Source:
Capella University ProQuest Dissertations Publishing

Pharmacy residents are especially vulnerable to burnout given the professional and personal stressors associated with postgraduate training. Residency programs need to prioritize burnout reduction strategies to support resident health and well-being. This commentary describes a resident-preceptor collaborative approach to encourage wellness and reduce burnout within a large residency program at an academic medical center. Strategies that have been utilized include (1) fostering collaboration among residents and preceptors; (2) assessing resident interests and needs to ensure alignment; (3) leveraging available institutional and community resources; and (4) integrating initiatives within the existing residency program structure. This commentary aims to provide suggestions that can be implemented to address resident burnout for other residency programs, regardless of resource availability.

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Publicly Available
A Resident-Preceptor Collaboration to Encourage Wellness and Reduce Burnout Amongst Pharmacy Residents
By
Booth, Jennifer P.; Aycock, Anna C.; Elefritz, Jessica L.; Gaborcik, Joshua W.; Wardlow, Lynn C.; Loborec, Jessica D.
Source:
American Journal of Pharmaceutical Education

Training and practicing physicians continue to experience burnout, poor job satisfaction / engagement, high stress, and even depression and suicide. With an understanding of effective and ineffective methods to improve wellness, our team aimed to collect publications with data on the effectiveness of physical activity interventions to address burnout and well-being in physicians. Comprehensive searches for articles related to the impact of exercise on physicians’ well-being were undertaken in March 2022 in PubMed, PsycINFO, and EMBASE. Of 2496 records identified in the databases, the team screened 1,287 and finalized 12 papers for inclusion and review. This study reviews the overall positive benefits of physical activity and exercise interventions in physicians. Despite the wide-ranging utility of an exercise prescription and despite clear evidence that physicians' personal exercise habits affect their patient counseling about exercise, this review shows that (often overburdened) physicians have insufficient physical activity, and are rarely included in studies targeting exercise. Many of the included studies had small sample sizes, leaving possibilities for future research aiming to augment physician wellness.

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Publicly Available
A Scoping Review of Physical Activity Interventions for Physician Wellness
By
Huecker, Martin; Genova, Gina; Shreffler, Jacob
Source:
American Journal of Lifestyle Medicine

BACKGROUND: Burnout is a growing problem among medical professionals, reaching a crisis proportion. It is defined by emotional exhaustion, cynicism, and career dissatisfaction and is triggered by a mismatch between the values of the person and the demands of the workplace. Burnout has not previously been examined thoroughly in the Neurocritical Care Society (NCS). The purpose of this study is to assess the prevalence, contributing factors, and potential interventions to reduce burnout within the NCS. METHODS: A cross-sectional study of burnout was conducted using a survey distributed to members of the NCS. The electronic survey included personal and professional characteristic questions and the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI). This validated measure assesses for emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). These subscales are scored as high, moderate, or low. Burnout (MBI) was defined as a high score in either EE or DP or a low score in PA. A Likert scale (0–6) was added to the MBI (which contained 22 questions) to provide summary data for the frequencies of each particular feeling. Categorical variables were compared using χ2 tests, and continuous variables were compared using t-tests. RESULTS: A total of 82% (204 of 248) of participants completed the entire questionnaire; 61% (124 of 204) were burned out by MBI criteria. A high score in EE was present in 46% (94 of 204), a high score in DP was present in 42% (85 of 204), and a low score in PA was present in 29% (60 of 204). The variables feeling burned out now, feeling burned out in the past, not having an effective/responsive supervisor, thinking about leaving one’s job due to burnout, and leaving one’s job due to burnout were significantly associated with burnout (MBI) (p < 0.05). Burnout (MBI) was also higher among respondents early in practice (currently training/post training 0–5 years) than among respondents post training 21 or more years. In addition, insufficient support staff contributed to burnout, whereas improved workplace autonomy was the most protective factor. CONCLUSIONS: Our study is the first to characterize burnout among a cross-section of physicians, pharmacists, nurses, and other practitioners in the NCS. A call to action and a genuine commitment by the hospital, organizational, local, and federal governmental leaders and society as a whole is essential to advocate for interventions to ameliorate burnout and care for our health care professionals.

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Publicly Available
A Survey of Burnout Among Neurocritical Care Practitioners
By
Aboutaleb, Pakinam E.; Salem, Mohamed M.; Adibnia, Yasaman; Lee, Lucia; Green-LaRoche, Deborah M.
Source:
Neurocritical Care

INTRODUCTION: The personality traits of those who become orthopaedic surgeons may also lead to overwork, work-life balance issues, and burnout. Health and wellness practices of orthopaedic surgeons have not been widely explored. This study evaluated the personal health habits, wellness, and burnout of practicing orthopaedic surgeons in the United States. METHODS: An anonymous self-assessment survey was completed by 234 practicing orthopaedic surgeon alumni from two large residency programs. The survey assessed exercise habits according to Centers for Disease Control and Prevention recommendations, compliance with preventive medical care practices according to the United States Preventive Services Task Force, prioritization of occupational wellness strategies, and the presence of burnout via an adapted Maslach Burnout Inventory. Survey responders' mean age was 52 years, 88% were male, and 93% had a body mass index <30 kg/m2. Surgeons were stratified according to practice type, years in practice, and subspecialty. RESULTS: Among orthopaedic surgeons, compliance with aerobic and strength exercise recommendations was 31%. Surgeons in academic practice were significantly (P = 0.007) less compliant with exercise recommendations (18%) compared with private (34%) or employed (43%) practicing surgeons. Most (71%) had seen their primary care provider within 2 years and were up to date on age-appropriate health care screening including a cholesterol check within 5 years (79%), colonoscopy (89%), and mammogram (92%). Protecting time away from work for family/friends and finding meaning in work were the most important wellness strategies. The overall burnout rate was 15% and remained not significantly different (P > 0.3) regardless of years in practice, practice type, or subspecialty. CONCLUSION: This survey study identifies practicing orthopaedic surgeons' health habits and wellness strategies, including limited compliance with aerobic and strength exercise recommendations. Orthopaedic surgeons should be aware of areas of diminished personal wellness to improve quality of life and avoid burnout.

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A Survey of Personal Health Habits, Wellness, and Burnout in Practicing Orthopaedic Surgeons—Are We Taking Care of Ourselves?
By
Thompson, Jeremy C.; VanWagner, Michael J.; Spaulding, Aaron C.; Wilke, Benjamin K.; Schoch, Bradley S.; Spencer-Gardner, Luke S.; Ledford, Cameron K.
Source:
JAAOS: Global Research and Reviews

OBJECTIVE: This systematic review and meta-analysis aims to explore overall prevalence of burnout among physicians during early and late COVID-19 pandemic and geographical differences in burnout. METHODS: This review was registered prospectively with PROSPERO (CRD42022327959). A comprehensive search of several databases, including Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, PsycINFO, and Scopus, spanning from December 2019 to May 2022 was conducted. Eligible studies included physicians or medical professionals including physicians that worked directly or indirectly with COVID-19 patients, whilst reporting burnout outcomes using a validated scale. Literature that did not include physicians or did not occur in a hospital setting were excluded. Literature including medical students were also excluded. RESULTS: Forty-five observational studies were included, all of which were cross-sectional studies. The pooled estimate of overall prevalence of burnout was 54.60% (95% CI: 46.7, 62.2). Mean emotional exhaustion, depersonalization, and personal accomplishment was found to be 22.06% (95% CI: 18.19, 25.94), 8.72 (95% CI: 6.48, 10.95) and 31.18 (95% CI: 27.33, 35.03) respectively. Frontline workers displayed higher rates of burnout than second-line healthcare workers (HCW) (OR: 1.64, 95% CI: 1.13, 2.37). Studies from the early pandemic period reported burnout prevalence of 60.7% (95% CI: 48.2, 72) compared to a prevalence of 49.3% (95% CI: 37.7, 60.9) from the late pandemic period. Geographically, burnout was highest amongst Middle East and North Africa (MENA) studies (66.6%, 95% CI: 54.7, 78.5), followed by Europe (48.8%, 95% CI: 40.3, 57.3) and then South America (42%, 95% CI: –0.4, 84.4). Lastly, burnout prevalence overall (OR = 0.77, 95% CI: 0.36, 1.67) emotional exhaustion (MD = –0.36, 95% CI: –4.64, 3.91), depersonalization (MD = –0.31, 95% CI: –1.80, 1.18), and personal accomplishment (MD = 0.55, 95% CI: –0.73, 1.83) were found comparable between physicians and nurses. CONCLUSION: COVID-19 has had significant consequences on HCW burnout. Further research is needed to examine early signs of burnout and to develop effective coping strategies.

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A Systematic Review and Meta Analysis on Burnout in Physicians during the COVID-19 Pandemic: A Hidden Healthcare Crisis
By
Macaron, Marie Michele; Segun-Omosehin, Omotayo Ayomide; Matar, Reem H.; Beran, Azizullah; Nakanishi, Hayato; Than, Christian A.; Abulseoud, Osama A.
Source:
Frontiers in Psychiatry

BACKGROUND: Weighing implications of multiple intensive cancer-directed therapies over time, oncology nurses are more prone to intrinsic distress compared to nurses in non-oncologic settings. This vulnerability may give rise to moral distress. Yet, little is known about moral distress experiences of oncology nurses. OBJECTIVE: This systematic review and meta-analysis examined the frequency and intensity of moral distress among oncology nurses with an exploratory focus on nurse-level and work-related characteristics. METHODS: We conducted a systematic search of 7 electronic databases (2000–2020) supplemented by hand-search strategy. Means and standard deviations of moral distress scores in the included studies were extracted and pooled in our meta-analysis. RESULTS: Our sample of 8 cross-sectional studies consisting of 2686 participants with 1654 oncology nurses met criteria for inclusion. A random-effects model was used in our meta-analysis given considerable heterogeneity. Our results suggest that moral distress was of low to moderate frequency, but of high intensity. Moral distress among oncology nurses was a significant predictor for burnout, provider communication, decisions surrounding end-of-life care, work conditions (eg, patient assignment, type of unit), and inability to provide compassionate care. CONCLUSION: Moral distress in oncology nurses is associated with burnout syndrome, compassion fatigue, and secondary traumatic stress syndrome, all of which are linked to poor patient care and outcomes. Robust psychological well-being is critical in minimizing unintended consequences of moral distress. IMPLICATIONS FOR PRACTICE: Oncology nurses are at high risk for moral distress due to the nature of their work. Future studies should examine the prevalence among oncology nurses to help inform targeted interventions.

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A Systematic Review and Meta-analytic Evaluation of Moral Distress in Oncology Nursing
By
Eche, Ijeoma Julie; Phillips, Carolyn S.; Alcindor, Nadia; Mazzola, Emanuele
Source:
Cancer Nursing

Ambulance services are changing, and the SARS-CoV-2 pandemic has been a major challenge in the past three years. Job satisfaction and work engagement are important characteristics for a healthy organization and success in one’s profession. The purpose of the current systematic review was to evaluate the predictors of job satisfaction and work engagement in prehospital emergency medical service personnel. Electronic databases, such as PubMed, Ovid Medline, Cochrane Library, Scopus, Web of Science, PsycINFO, PSYNDEX, and Embase, were utilized in this review. Predictors (ß coefficient, odds ratio, rho) of higher job satisfaction and work engagement were examined. Only prehospital emergency medical service personnel were considered. The review included 10 studies worldwide with 8358 prehospital emergency medical service personnel (24.9% female). The main predictor for job satisfaction was supervisors’ support. Other predictors were younger or middle age and work experience. Emotional exhaustion and depersonalization, as burnout dimensions, were negative predictors for higher job satisfaction or work engagement. Quality demands for health care systems are a significant challenge for future emergency medical services. The psychological and physical strengthening of employees is necessary and includes constant supervision of managers or facilitators.

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A Systematic Review of Associations and Predictors for Job Satisfaction and Work Engagement in Prehospital Emergency Medical Services—Challenges for the Future
By
Thielmann, Beatrice; Schwarze, Robin; Böckelmann, Irina
Source:
International Journal of Environmental Research and Public Health

This systematic review investigates the association between coping strategies and burnout in emergency workers. Three electronic databases were searched. Eleven eligible articles were extracted, and quality assessed. Findings were integrated through narrative synthesis, highlighting clear methodological issues around conceptualizing, and measuring coping strategies and burnout with agreed upon tools. This review found no convincing evidence to suggest coping strategies have a meaningful relationship with burnout in emergency workers, questioning the evidence base for psychological interventions focusing on modifying coping strategies to target burnout. To understand the true impact of coping strategies on burnout, more longitudinal designs, and an agreed, validated measure for coping is needed.

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A Systematic Review of the Relationship Between Burnout and Coping Strategies in Emergency Workers
By
Diggin, Shannon; Smith, Léonie; Kirkpatrick, Ruth; Dempster, Martin
Source:
Journal of Workplace Behavioral Health

The hospital association says it is focusing advocacy on workplace violence, Medicare residency slots, the nursing shortage, and workforce diversity.

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AHA Exec: 'Workforce Is the Number One Concern for Hospitals Across the Country'
By
Cheney, Christopher
Source:
HealthLeaders

PURPOSE: Results of the 2022 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented. METHODS: Pharmacy directors at 1,498 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA’s hospital database. RESULTS: The response rate was 23.7%. Inpatient pharmacists independently prescribe in 27.1% of hospitals. Advanced analytics are used in 8.7% of hospitals. Pharmacists work in ambulatory or primary care clinics in 51.6% of hospitals operating outpatient clinics. Some level of pharmacy service integration is reported in 53.6% of hospitals. More advanced pharmacy technician roles are emerging. For health systems offering hospital at home services, 65.9% of pharmacy departments are involved. Shortages of pharmacists and technicians were reported but are more acute for pharmacy technicians. Aspects of burnout are being measured in 34.0% of hospitals, and 83.7% are attempting to prevent and mitigate burnout. The average number of full-time equivalents per 100 occupied beds is 16.9 for pharmacists and 16.1 for pharmacy technicians. CONCLUSION: Health-system pharmacies are experiencing workforce shortages; however, these shortages have had limited impact on budgeted positions. Workforce challenges are influencing the work of pharmacists and pharmacy technicians. Adoption of practice advancement initiatives has continued the positive trend from past years despite workforce issues.

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ASHP National Survey of Pharmacy Practice in Hospital Settings: Workforce — 2022
By
Pedersen, Craig A; Schneider, Philip J; Ganio, Michael C; Scheckelhoff, Douglas J
Source:
American Journal of Health-System Pharmacy

A revolutionary academic-practice partnership model was implemented at the University of Maryland Medical System (UMMS) with the University of Maryland School of Nursing, through which the preparation and transition to practice of new graduate nurses were reimagined, resulting in intentional support for staffing the nursing workforce. Groups of nursing students were paired with a UMMS-funded clinical instructor to take a full patient assignment for one 12-hour shift in a UMMS hospital each week. This instructor-led cohort is equivalent to one UMMS nurse and was included in the staffing numbers of participating units.

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Academy of Clinical Essentials: A Revolutionary Nurse Staffing and Education Model
By
Rowen, Lisa; Howett, Maeve; Embert, Casey; Beeson, Nicole; Bosah, Barbara; Chen, Lynn; Day, Jennifer; Nichols, DoRhonja; O'Malley, Cassie
Source:
JONA: The Journal of Nursing Administration

BACKGROUND: Staff working in people-oriented professions are vulnerable to burnout which is negatively associated with professional well-being and service-user care. AIM: To investigate if interventions based on Acceptance and Commitment Therapy (ACT) are effective in reducing staff burnout. METHOD: Systematic database and reference list searches were conducted resulting in the inclusion of 14 quantitative papers. A narrative synthesis, including extraction of individual effect sizes, was performed. RESULTS: All studies were controlled trials. The settings for ACT delivery were varied across health, social care, and public services. The ACT interventions demonstrated statistically significant effects in favour of ACT on the outcome measure subscales across the majority of studies (n = 9). Thirteen studies demonstrated an effect in favour of ACT in at least one outcome measure subscale. Positive aspects of work engagement varied according to a professional role. CONCLUSIONS: The findings suggest that ACT-based interventions using a wide range of formats may have the potential to decrease burnout across a range of professional groups. However, samples were small in the studies reviewed and the interventions were not always defined. Further research would benefit from larger studies, incorporating process measures, with explicit protocols.

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Acceptance and Commitment Therapy (ACT) for Professional Staff Burnout: A Systematic Review and Narrative Synthesis of Controlled Trials
By
Towey-Swift, Kim D.; Lauvrud, Christian; Whittington, Richard
Source:
Journal of Mental Health

INTRODUCTION: Physician burnout has been described as more common among women than men.  Even if there are no gender-based differences in prevalence, risk factors, such as work/home integration/conflict and gendered biases, likely differ.  Prior administrations of an annual resident wellness survey at a single urban academic institution confirmed that rates of burnout were higher among women, especially during the PGY-2 year.

METHODS: A series of focus groups of women PGY-3 residents across specialties were organized in 2019 at a single urban academic medical center.  Given the number of participants, demographics were not collected to maintain participant anonymity.  The moderator for all groups used a discussion guide consisting of eight open-ended questions based on a review of the literature.

RESULTS: Ten residents agreed to participate in one of four, hour-long focus group discussions.  While the residents identified some factors that were not gender-specific, they also discussed issues that they faced as women in medicine, including needing to work harder to prove themselves and unconscious gendered biases from faculty and patients.  The residents thought that their wellbeing would be improved if their training programs better understood the experiences and needs of women residents and recommended a series of interventions, including improved mentoring and networking opportunities.

CONCLUSIONS: Interventions to improve wellbeing need to consider gender-based differences.  While mentoring and networking can help all residents, these may be especially useful for women and should be considered as a component of an overarching plan to improve diversity, equity, inclusion, and belonging.

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Addressing Burnout among Women Residents: Results from Focus Group Discussions
By
Norvell, Jeffrey; Unruh, Greg; Norvell, Timothy; Templeton, Kimberly
Source:
Kansas Journal of Medicine

BACKGROUND: Significant progress has been made in understanding the factors associated with oncology (onc) PA burnout. However, little is known about what PAs need to mitigate burnout, the availability of resources, and barriers to interventions. METHODS: A national survey of onc PAs was conducted in 2022. PAs completed a quantitative needs assessment to determine the importance of and their perceived skills in topics of self-care, clinical care, and professional development. For importance, “high importance” included ratings of ‘Essential’ or ‘Very Important’; for perceived skill, “high skill” included ratings of ‘Excellent’ or ‘Good’. Engagement with employee assistance programs (EAPs) was examined. Resiliency & Burnout were assessed using the Connor-Davidson Resilience Scale & the Maslach Burnout Inventory. RESULTS: PAs (n = 171) were mostly practicing in medical oncology (66%) and outpatient (66%). The high importance topics most often identified were dealing with difficult patients (93%), dealing with difficult providers (89%), delivering bad news (88%) and coping with death / patient suffering and personal grief (86%). Topics less often reported as high importance included opportunities to be a mentor (61%), professional coaching (59%) and mindfulness skills (53%). PAs frequently reported high skills in dealing with difficult patients (75%), delivering bad news (72%), and resiliency skills (59%). Fewer PAs reported high skills for debriefing following significant events (49%) and mindfulness skills (42%). Burnout (BO) rates were higher for those with lower perceived skills in resiliency (p = 0.03) and dealing with difficult providers and staff (p = 0.03) but did not differ based on importance of any topics. Resiliency significantly increased with increasing levels of reported importance for the mindfulness skills training, cognitive skills training, and debriefing after significant events topics. Resiliency significantly increased with increased levels of perceived skill for all topics explored. Common barriers to well-being EAP participation were lack of time (58%) and concerns about confidentiality and stigma (26%). For PAs with concerns about stigma, resiliency scores were lower (6.4 vs 7.0; p < 0.001) and BO rates were higher (73% vs 47%; p = 0.005). CONCLUSIONS: Perceived deficiencies in resiliency training and managing difficult work relationships correlate with higher rates of burnout in onc PAs. Barriers to participation in EAPs, which may help address these deficits, are common and when present are associated with an alarming rate of burnout and lower resiliency. Cultural change in medicine is needed to reduce perceived and experienced stigmatizing experiences to address burnout. These findings suggest that burnout interventions which focus on building resiliency and managing work relationships are crucial and may be best implemented outside of the workplace.

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Addressing Resiliency and Burnout: A Quantitative Needs Assessment of Oncology Physician Assistants (PAs).
By
Tetzlaff, Eric Daniel; Hylton, Heather Marie; Ruth, Karen J; Hasse, Zachary; Hall, Michael J.
Source:
Journal of Clinical Oncology

Physician burnout is an epidemic and there are unique aspects of surgery that dictate rates of burnout among general surgeons and surgical trainees. This review characterizes the scope of burnout and its drivers within the field of surgery and advocates for strategies to address burnout at the individual, institutional, and national levels.

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Addressing Surgeon Burnout Through a Multi-level Approach: A National Call to Action
By
Golisch, Kimberly B.; Sanders, Jes M.; Rzhetsky, Anna; Tatebe, Leah C.
Source:
Current Trauma Reports

[This is an excerpt.] “Some people just don’t know when to quit.” It might be time to retire this old cliché. As it turns out, people do know when to quit, and they’re quitting their jobs by the millions. “The Great Resignation,” a term coined in May 2021, is an economic trend in which millions of workers are quitting their jobs, switching industries, moving into nontraditional roles, retiring early, and reinventing their ideal career. The numbers are staggering. According to the U.S. Bureau of Labor Statistics, more than 47 million Americans left their jobs in 2021. The trend doesn’t seem to be slowing down either, as a McKinsey report published in July 2022 found that 40% of employees are currently considering leaving their jobs. [To read more, click View Resource.]

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Addressing the Healthcare Staffing Shortage
By
Popowitz, Ethan
Source:
Definitive Healthcare

Mental health professionals working in the juvenile justice system work with clients who have complex mental health needs putting them at increased risk of burnout and vicarious trauma. Clinical supervision can help beginning counselors provide competent services and, at the same time, protect them from burnout. This article shows how supervisors can use an Adlerian-informed supervision method that integrates the Respectfully Curious Inquiry/Therapeutic Encouragement (RCI/TE) framework with the discrimination model of supervision to increase the supervisee’s experience of the Crucial Cs. Supervisors can protect supervisees from burnout and vicarious trauma by increasing feelings of connection, significance, competence, and courage. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

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Adlerian-Informed Supervision: Protecting Counselors from Burnout and Improving Client Outcomes in the Juvenile Justice System
By
McCarty, Danny L.; Christian, David D.; Stefurak, Tres
Source:
Psychological Services

Occupational burnout has become widespread. The syndrome can be especially harmful in health care settings, affecting clinicians, organizational effectiveness, and patient safety. Certain approaches have proven helpful in some cases in combatting the syndrome. The coronavirus pandemic presented physicians with unique challenges, which appeared to have magnified work stress This national survey specifically explored interventions used by health care leaders to reduce burnout and whether these interventions proved effective during a pandemic. We also discuss effective and appropriate organizational measures to reduce physician burnout and its associated risks during crises.

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Administrators’ Preparedness to Address Physician Burnout Before and During COVID‐19
By
Schoolcraft, Payton L.; Brown, Stephen L.; Xie, Yue
Source:
Journal of Healthcare Risk Management

Law enforcement and child welfare professionals experience ongoing exposure to work-related traumatic events as a natural part of their occupation. This exposure results in a higher level of vicarious trauma in these professions. Many professionals in these professions have also experienced a statistically higher number of adverse childhood experiences. As a result, they are exposed to more cumulative trauma over time. Also associated with other high-stress and high- stakes work environments, like military service members, is moral injury. Adverse childhood experiences, vicarious trauma, and moral injury are correlated with post-traumatic stress symptoms, negative emotions and behaviors, and suicidality. This research examined the relationship between adverse childhood experiences, vicarious trauma, and moral injury in professionals serving in law enforcement and child welfare. The presence of early positive childhood experiences was considered as a buffer from these variables. The association of moral injury and cumulative trauma experiences was examined using the following measures: the Adverse Childhood Experiences Questionnaire (ACE), Vicarious Trauma Scale (VTS), Moral Injury Assessment for Public Safety Personnel (MIA-PSP), and Positive Childhood Experiences Questionnaire (PCE). Data on age, sex, type of profession, size of the organization, military service status, and total years of service experience were collected and analyzed as other potential predictor variables. Individuals currently serving as law enforcement or child welfare professionals were recruited through the distribution of online surveys, with the necessary minimum sample size being 76 participants. The results from the screening measures were analyzed utilizing a Pearson correlation and multiple linear regression analyses to determine the relationship between adverse childhood experiences, vicarious trauma, and moral injury and how they are moderated by positive childhood experiences.

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Adverse Childhood Experiences and Moral Injury in Law Enforcement and Child Welfare Professionals Exposed to Work-Related Vicarious Trauma
By
Burkett, Lori
Source:
Alliant International University ProQuest Dissertations Publishing

We examined the relationship between age, coping, and burnout during the peak of the COVID-19 pandemic with nurses in Texas (N = 376). Nurses were recruited through a professional association and snowball sampling methodology for the cross-sectional survey study. Framed in lifespan development theories, we expected that nurse age and experience would be positively correlated with positive coping strategies (e.g., getting emotional support from others) and negatively correlated with negative coping strategies (e.g., drinking and drug use). We also expected age to be negatively related to the emotional exhaustion and depersonalization facets of burnout and positively related to the personal accomplishment facet of burnout. Findings were largely supported in that age was positively associated with positive coping and personal accomplishment and age and experience were negatively correlated with negative coping and depersonalization. Age was not, however, associated with emotional exhaustion. Mediation models further suggest that coping explains some of the effect of age on burnout. A theoretical extension of lifespan development models into an extreme environment and practical implications for coping in these environments are discussed.

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Aging and Burnout for Nurses in an Acute Care Setting: The First Wave of COVID-19
By
Beier, Margaret E.; Cockerham, Mona; Branson, Sandy; Boss, Lisa
Source:
International Journal of Environmental Research and Public Health

The COVID-19 pandemic has required close examination of workforce-related stressors that over decades have contributed to widespread burnout, negative health outcomes, including mental health outcomes, and the loss of the well-educated professionals who are the future of the nursing profession. In the United States and globally, evidence points to factors known to diminish well-being, including inequities, issues of minority status, persistent discrimination, and demanding work environments. The American Academy of Nursing (AAN), dedicated to organizational excellence, nursing leadership and evidence-based policy, develops statements reflecting its mission and those of its nursing affiliates and corporate member, The American Nurses Association. Within nursing, despite the efforts of its members toward advancement, professional fulfillment is often constrained by the systems in which nurses practice and workplace factors over which they have little control. Action by key organizations to initiate changes at systems levels in workplace safety, to increase professional mobility, and propel policies that increase access to health care resources could improve nurse well-being. This paper proposes recommendations from the AAN Expert Panels on Building Health Care System Excellence, Psychiatric Mental Health and Substance Use, and Global Health Expert Panels for the American Academy of Nursing to leverage related policy in the arenas of government and professional/healthcare organizations. Transforming health care work environments and advancing nurse well-being and equity can be accomplished through key, innovative policy changes. These will be achieved through collaboration among associations, organizations, nonprofit groups, and with the public and the media.

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American Academy of Nursing Consensus Recommendations to Advance System Level Change for Nurse Well-Being
By
Naegle, Madeline A.; Kelly, Lesly A.; Embree, Jennifer L.; Valentine, Nancy; Sharp, Daryl; Grinspun, Doris; Hines-Martin, Vicki P.; Crawford, Cecelia L.; Rosa, William E.
Source:
Nursing Outlook

BACKGROUND: The American College of Radiology (ACR) passed a historic paid family/medical leave (PFML) resolution at its April 2022 meeting, resolving that “diagnostic radiology, interventional radiology, radiation oncology, medical physics, and nuclear medicine practices, departments and training programs strive to provide 12 weeks of paid family/medical leave in a 12-month period for its attending physicians, medical physicists, and members in training as needed.” The purpose of this article is to share this policy beyond radiology so that it may serve as a call to action for other medical specialties. PRINCIPAL FINDINGS: Such a PFML policy (1) supports physician well-being, which in turn supports patient care; (2) is widely needed across American medical specialties; and (3) should not take nearly a decade to achieve, as it did in radiology, especially given increasing physician burnout and the ongoing COVID-19 pandemic. CONTRIBUTION: Supported by information on the step-by-step approach used to achieve radiology-specific leave policies and considering current and normative policies at the national level, this article concludes by reviewing specific strategies that could be applied toward achieving a 12-week PFML policy for all medical specialties.

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American College of Radiology Paid Family/Medical Leave Policy: A Call to Action for the House of Medicine
By
Arleo, Elizabeth Kagan; Porter, Kristin K.; Magudia, Kirti; Englander, Meredith; Deitte, Lori A.
Source:
Journal of Women's Health

PURPOSE: The purpose of the study’s mixed-methods evaluation was to examine the ways in which a relational leadership development intervention enhanced participants’ abilities to apply relationship-oriented skills on their teams. DESIGN/METHODOLOGY/APPROACH: The authors evaluated five program cohorts from 2018–2021, involving 127 interprofessional participants. The study’s convergent mixed-method approach analyzed post-course surveys for descriptive statistics and interpreted six-month post-course interviews using qualitative conventional content analysis. FINDINGS: All intervention features were rated as at least moderately impactful by at least 83% of participants. The sense of community, as well as psychological safety and trust created, were rated as impactful features of the course by at least 94% of participants. At six months post-intervention, participants identified benefits of greater self-awareness, deeper understanding of others and increased confidence in supporting others, building relationships and making positive changes on their teams. ORIGINALITY/VALUE: Relational leadership interventions may support participant skills for building connections, supporting others and optimizing teamwork. The high rate of skill application at six months post-course suggests that relational leadership development can be effective and sustainable in healthcare. As the COVID-19 pandemic and systemic crises continue to impact the psychological well-being of healthcare colleagues, relational leadership holds promise to address employee burnout, turnover and isolation on interprofessional care teams.

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An Antidote to What’s Ailing Healthcare Workers: A New (Old) Way of Relational Leadership
By
Park, Brian; Tuepker, Anaïs; Vasquez Guzman, Cirila Estela; Edwards, Samuel; Waller Uchison, Elaine; Taylor, Cynthia; Eiff, M. Patrice
Source:
Leadership in Health Services

Depolicing is a behavior that occurs when law enforcement officers disengage from proactive police work. Despite the term’s more recent popularity, these behaviors have been identified in policing literature for decades. Scholars have primarily tried to quantify the depolicing phenomenon through the lens of public scrutiny and the Ferguson Effect. However, there are currently no quantitative studies that have attempted to examine the multitude of reasons as to why depolicing behavior could potentially occur. The current inquiry uses survey data retrieved from eight municipal law enforcement agencies to further examine potential predictors of depolicing. The predictor variables consisted of public scrutiny, liability concerns, organizational unfairness, burnout, physical danger, COVID-19, and years of experience. Our results indicate that public scrutiny, liability concerns, COVID-19, and years of experience are all significant and positive predictors of depolicing. We also found that agency location and rank significantly impacted depolicing behavior. The findings and limitations are discussed.

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An Empirical Analysis of Depolicing Behavior
By
Foster, Jacob T.; Rossler, Michael T.; Scheer, Charles
Source:
Police Practice and Research

BACKGROUND: Nurses experienced physical and mental exhaustion during the COVID-19 pandemic. Understanding the impact of the pandemic on nurses and effective strategies to support them is critical for increasing nurse resilience and reducing burnout. AIMS: The aims of this study were (1) to synthesize the literature examining how factors associated with the COVID-19 pandemic affected the well-being and safety of nurses (2) and to review interventions which may promote nurse mental health during crises. METHODS: Using an integrative review approach, a comprehensive search of the literature was conducted in March 2022 using the following databases: PubMed, CINAHL, Scopus, and Cochrane. We included quantitative, qualitative, and mixed-method primary research articles published in English in peer-reviewed journals from March 2020 through February 2021. Included articles focused on nurses caring for COVID-19 patients and addressed psychological factors, supportive hospital leadership strategies, or interventions to support well-being. Studies were excluded if they focused on professions outside of nursing. Included articles were summarized and appraised for quality. Findings were synthesized using content analysis. RESULTS: Of the 130 articles initially identified, 17 were included. Articles were quantitative (n = 11), qualitative (n = 5), and mixed methods (n = 1). Three themes were identified: (1) loss of life, hope, and professional identity; (2) lack of visible and supportive leadership; and (3) insufficient planning and response. These experiences contributed to increased symptoms of anxiety, stress, depression, and moral distress in nurses.

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An Integrative Review of Factors and Interventions Affecting the Well‐Being and Safety of Nurses During a Global Pandemic
By
Boone, Lesa D.; Rodgers, Melanie M.; Baur, April; Vitek, Elaine; Epstein, Crystal
Source:
Worldviews on Evidence-Based Nursing

Frontline clinicians responding to the COVID-19 pandemic are at increased risk of burnout, but less is known about the trajectory of clinician burnout as caseloads increase and decrease. Personal and professional resources, including self-efficacy and hospital support, can attenuate the risk of burnout. Yet, empirical data documenting how burnout and resources changed as the pandemic waxed and waned are limited. This intensive longitudinal prospective study employed ecological momentary assessment methods to examine trajectories of burnout and resources over the pandemic’s first year in a New York City hospital. A 10-item survey was emailed every 5 days to frontline clinicians (physicians, nurses, and physician assistants). The primary outcome was a single-item validated measure of burnout; predictors included daily hospital COVID-19-related caseloads and personal and professional resources. Clinicians (n = 398) completed the initial survey and an average of 12 surveys over the year. Initially, 45.3% of staff reported burnout; over the year, 58.7% reported burnout. Following the initial COVID peak, caseloads declined, and burnout levels declined. During the second wave of COVID, as caseloads increased and remained elevated and personal and professional resource levels decreased, burnout increased. This novel application of intensive longitudinal assessment enabled ongoing surveillance of burnout and permitted us to evaluate how fluctuations in caseload intensity and personal and professional resources related to burnout over time. The surveillance data support the need for intensified resource allocation during prolonged pandemics.

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An Intensive Longitudinal Assessment Approach to Surveilling Trajectories of Burnout over the First Year of the COVID Pandemic
By
Pan, Cynthia X.; Crupi, Robert; August, Phyllis; Sundaram, Varuna; Norful, Allison A.; Schwartz, Joseph E.; Miele, Andrew S.; Simons, R. Rhiannon; Mikrut, Emilia E.; Brondolo, Elizabeth
Source:
International Journal of Environmental Research and Public Health

PURPOSE: The purpose of this investigation was to develop, describe, and evaluate burnout curricula using meditation as a burnout reduction strategy. METHOD: The Maslach Burnout Inventory was the survey method used to assess PA student’s levels of burnout after completing developed burnout curricula. RESULTS: The results showed no relationship between burnout curricula completion and rates of student burnout. However, the findings showed burnout differences across the three cohorts of student classes. CONCLUSION: While limited by only the three cohorts of students, the study affirmed the need for faculty to stay attuned to aspects of student burnout.

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An Investigation of Burnout and the Use of Meditation as Means of Prevention in a Program of Study for Physician Assistants
By
Chappell, Rachel; Hebert, George; Weydert, Amber
Source:
Internet Journal of Allied Health Sciences and Practice

Anger is an emotional state that occurs when unexpected things happen to or around oneself and is “an emotional state that varies in intensity from mild irritation to intense fury and rage.” It is defined as “a strong feeling of displeasure and usually of antagonism,” an emotion characterized by tension and hostility arising from frustration, real or imagined injury by another, or perceived injustice. It can manifest itself in behaviors designed to remove the object of the anger (e.g., determined action) or behaviors designed merely to express the emotion. For the Roman philosopher Seneca anger is not an uncontrollable, impulsive, or instinctive reaction. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It seems that the year 2022 was a year when many Americans were plainly angry. “Why is everyone so angry?” the New York Times asked in the article “The Year We Lost It.” We believe that Seneca is correct in that anger is unacceptable. Anger is a negative emotion that must be controlled, and Seneca provides us with the tools to avoid and destroy anger. Health care professionals will be more effective, content, and happier if they learn more about Seneca’s writings about anger and implement his wisdom on anger from over 2000 years ago.

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Publicly Available
Anger: An Underappreciated Destructive Force in Healthcare
By
Grünebaum, Amos; McLeod-Sordjan, Renee; Pollet, Susan; Moreno, John; Bornstein, Eran; Lewis, Dawnette; Katz, Adi; Warman, Ashley; Dudenhausen, Joachim; Chervenak, Frank
Source:
Journal of Perinatal Medicine

Women represent almost half of all practicing surgeons in the USA; however, women continue to struggle with achieving equity in compensation, recruitment, promotion, and work-life balance. A review of recent literature about gender disparities in medicine, with focus on trauma surgery, was performed to better understand the issues and seek solutions.

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Publicly Available
Are We There Yet? No. Gender Disparities Still Exist and Affect Surgeon Burnout
By
Lake, Zoe; Dunford, Gretchen; Hunter, Jocelyn; Berry, Stepheny
Source:
Current Trauma Reports

[This is an excerpt.] Resident-related research is pervasive throughout medical literature. Frequent areas of investigation include physical stress, burnout, and mental health. These critical studies aid in the improvement of curriculums, augmentation of resources, and over-all advancement of training programs. As a go-to convenience sample, residents are routinely approached to participate in a variety of studies during their training. These studies are frequently resident and faculty led, from within their current institution or those of potential future fellowship training or professional positions. Residents’ high-levels of education and in-depth knowledge of scientific practices belies the vulnerability of this captive group. The complexity of resident status within the hierarchy of graduate medical education structures and the factors motivating them to participate in scientific inquiry need to be investigated. Ethical considerations regarding residents’ diminished states of health during these intense years of training and the collection of health-related data should also be examined. In the current literature, issues related to coercion, collection of sensitive data, and participant risk are underdeveloped for resident participants in scientific study. [To read more, click View Resource.]

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Publicly Available
Assessing Resident Well-Being: Ethical Considerations for Researchers When Conducting Qualitative Wellness Research With Resident Populations
By
Maksutova, Mariam; Kemp, Michael T.; Evans, Julie; Sharma, Sriganesh B.; Vercler, Christian; Sandhu, Gurjit
Source:
Annals of Surgery Open

The COVID-19 pandemic altered work environments of nurses, yielding high rates of stress and burnout. Potential protective factors, including effective sleep, may influence psychological health and wellbeing. Evidence about sleep in nurses may help develop interventions that mitigate burnout and poor psychological outcomes. A cross sectional survey was distributed across three hospitals to nurses in New York City (NYC). During the first wave of the pandemic (March-April 2020), NYC had the highest incidence of laboratory-confirmed COVID-19 cases (915/100 000) and half of all COVID-related deaths nationwide. Multivariable logistic regression was used to determine associations between Pittsburgh Sleep Quality Index (PSQI) global sleep score, PSQI sleep dimensions, and psychological health (burnout, depression, anxiety, and compassion fatigue), unadjusted and then controlling for individual and professional characteristics. More than half of the participants reported burnout (64%), depression, (67%), and anxiety (77%). Eighty percent of participants had PSQI global scores >5 (poor sleep) (mean 9.27, SD 4.14). Respondents reporting good sleep (PSQI less than or equal to 5) had over five times the odds of no burnout (OR: 5.65, 95% CI: 2.60, 12.27); increased odds of screening negative for depression (OR: 6.91, 95% CI: 3.24, 14.72), anxiety (OR: 10.75, 95% CI: 4.22, 27.42), and compassion fatigue (OR: 7.88, 95% CI: 1.97, 31.51). Poor subjective sleep quality PSQI subcomponent was associated with burnout (OR: 2.21, 95% CI: 1.41, 3.48) but sleep duration subcomponent was not (OR: 0.84, 95% CI: 0.59, 1.19). Daytime dysfunction was significantly associated with all psychological outcomes. Sleep disturbances and medications yielded higher anxiety odds. Overall, sleep quality appears more strongly related to burnout than sleep duration in nurses working during the COVID-19 pandemic. Sleep interventions should target individual sleep dimensions in nurses.

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Publicly Available
Assessing Sleep Health Dimensions in Frontline Registered Nurses during the COVID-19 Pandemic: Implications for Psychological Health and Wellbeing
By
Norful, Allison A.; Haghighi, Fatemeh; Shechter, Ari
Source:
Sleep Advances: A Journal of the Sleep Research Society

INTRODUCTION: Student well-being is a growing area of interest, though existing literature assessing multiple areas of well-being is lacking. This study aimed to evaluate the well-being of pharmacy students corresponding to three well-being domains (physical health, mental health, personal well-being and burnout) and identify characteristics associated with these domains. METHODS: An online survey adapted from various instruments was disseminated to pharmacy students from 11 pharmacy programs. Survey responses were compared using basic descriptive statistics, and Pearson's chi-Square was used for association analyses. RESULTS: Eight hundred thirty-six students from responded to the survey (24.3% response rate). For physical health, 59.3% of students reported sleeping <7  hours per night and 60.4% reported exercising 1 to 5  hours per week. For mental health, 24.8% of students screened positive for depression and 42% screened positive for anxiety. Lastly, 65.9% of students were at risk for decreased well-being and 63.7% for burnout. Based on association analyses, gender and pharmacy year were associated with screening positive for anxiety and burnout, gender was associated with decreased well-being, and relationship status was associated with screening positive for depression. CONCLUSIONS: This study revealed pharmacy students are at risk for lack of sleep and exercise, depression or anxiety, decreased well-being, and burnout. Also, several characteristics were found to be associated with these negative well-being outcomes. Although response rate and participant demographics could impact the generalizability of these findings, findings further increase awareness about student well-being and inform pharmacy programs supporting well-being by better understanding student risks.

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Assessing the Mental Health, Physical Health, and Well-Being of Doctor of Pharmacy Students
By
Nguyen, Mimi D.; Stocks, Abby MacCauley; Anksorus, Heidi N.; Harris, Suzanne C.
Source:
Currents in Pharmacy Teaching and Learning

BACKGROUND: Research has not explicitly explored differences between male and female microvascular head and neck (MHN) surgeon burnout, which should be identified and addressed to ensure career satisfaction and longevity. OBJECTIVE: To measure and compare the prevalence of burnout among male versus female MHN surgeons. METHODS: A prospective questionnaire based on the Maslach Burnout Inventory (MBI) was distributed through a web-based survey to the American Association of Facial Plastic and Reconstructive Surgeons and American Head and Neck Society in 2021 and 2022. Additional variables collected included demographics, relationship and parental status, academic rank, annual salary, and COVID-19-related questions. RESULTS: One hundred thirteen surveys were collected. Twenty-nine (25.7%) were women and all completed MHN surgery fellowships. Women trended toward more emotional exhaustion than men (2.8 mean MBI vs. 2.3 mean MBI) but reported similar personal achievement (4.8 mean MBI vs. 4.9 mean MBI). Men experienced less workplace sexual harassment (p < 0.001). Women experienced more burnout (69% vs. 39%, p = 0.006) during the COVID-19 pandemic. CONCLUSION: Female MHN surgeons reported in this survey to experience more workplace sexual harassment and higher COVID-19-related burnout than their male counterparts.

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Assessing the Prevalence of Burnout Among Female Microvascular Head and Neck Surgeons
By
Benjamin, Tania; Gulati, Arushi; Zebolsky, Aaron L.; Seth, Rahul; Knott, P. Daniel; Okuyemi, Oluwafunmilola; Park, Andrea M.
Source:
Facial Plastic Surgery & Aesthetic Medicine

PURPOSE/OBJECTIVES: Case management in Veterans Affairs (VA) depends on leadership skills such as effective communication, excellent resource management, self-governance, patient advocacy, and a distinctly professional attitude. VA registered nurses (RNs) and social workers (SWs) also provide case management services, a role and service, which is pivotal to veteran satisfaction and effective health care coordination. The leader-follower framework (LF2) was used to assess and compare the responses of RNs, SWs, and case managers (CMs) on the annual VA All Employee Survey (AES) to provide insight regarding VA case management performance, which has influenced veteran satisfaction. PRIMARY PRACTICE SETTING: VA CMs work in a variety of clinical settings, which, in recent years, includes the use of telehealth modalities because of COVID-19. VA CMs remain flexible working in environments where and when veterans require their services while promoting safe, effective, and equitable health care services. FINDINGS/CONCLUSIONS: RNs and SWs indicated greater agreement and satisfaction scores in 2019 compared with 2018 on questions related to the leadership element of character and questions regarding mutual respect between VA senior leaders and the respondents. In contrast, RNs and SWs indicated less agreement and satisfaction scores on questions related to the leadership elements of competence, context, communication, personal, interpersonal, team, organizational, and greater burnout in 2019 than in 2018. RN response scores in 2018 and 2019 were greater and burnout scores were less than SWs. Additionally, the one-way analysis of variance indicated no difference for RNs and SWs who were performing the duties of a CM. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The responses of RNs indicated greater satisfaction and less burnout than SWs and were consistent whether RNs and SWs were in case management roles or not. These are important findings and concerning trends warranting further discussion and research. © 2023 Lippincott Williams and Wilkins. All rights reserved.

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Publicly Available
Assessment of Veterans Affairs Case Managers Using a Leadership Conceptual Framework
By
Perla, L.Y.; Barry, E.S.; Grunberg, N.E.
Source:
Professional Case Management

OBJECTIVES: Second victim syndrome refers to the negative mental and emotional after-effects physicians may experience after adverse patient outcomes. We evaluated the impact of second victim status on physician self-efficacy, burnout, perceived stress, and sleep patterns.

METHODS: Physicians at a university hospital voluntarily participated in an anonymous, survey which included second victim status, General Self-Efficacy Scale (GSE), Copenhagen Burnout Inventory (CBI), Perceived Stress Scale (PSS), and Insomnia Severity Index. The total possible survey points were: GSE, 40; CBI, 95; PSS, 40; and Insomnia Severity Index, 28. The Student t test for independent samples and Mantel-Haenszel were used to compare second victim with nonsecond victims.

RESULTS: Of the 115 respondents, 85 (74%) provided second victim status: 48% female, 93% non-Hispanic White, 35% surgeons, and 53% in practice for more than 20 years. There were 24 (28%) self-reported second victims. Demographics were similar between groups. GSE scores were comparable: second victim versus nonsecond victim: 31.4 vs 32.6 (P = .13), but fewer second victims reported that they could accomplish their goals (79.2 vs 88.7%; P = .03). Overall, 56% of physicians had CBI scores consistent with moderate burnout. Mean CBI scores were similar for both groups 56.6 vs 52.4; P = .17). Work-related burnout (22.9 vs 21.9; P = .44) and personal burnout (18.9 vs 17.3; P = .17) were comparable, but second victims more commonly reported patient-related burnout (15.3 vs 12.9; P = .039). Second victims responded often or always more frequently to questions regarding patients being hard to work with (8.3% vs 1.6%; P = .03), frustrating (12.5% vs 3.3%; P = .02), draining energy (16.7% vs 5%; P = .018), or wondering how long they could continue to work with patients (16.7% vs 11.5%; P = .039). There was no difference in mean PSS for lack of control (11.7 vs 10.5; P = .28) or ability to cope with existing stressors (10.0 vs 10.6; P = .34). Mean insomnia scores were comparable (9.4 vs 7.7; P = .22), but second victims experienced problems with waking too early more often (29.2% vs 14.5%; P = .01). Official debriefing and individualized counseling or coaching to cope with the event were top resources desired by second victims (54%). Mandatory time off or mandatory meetings with a psychiatrist or psychologist were least favored (8%).

CONCLUSIONS: More than 25% of physicians have experienced second victim sequalae, which do not distinguish by demographics. Despite high-level GSE, moderate burnout was present in more than 50% of physicians, irrespective of second victim status. Patient-related burnout was particularly evident among second victims. These numbers are alarming and should be addressed promptly by medical societies and hospitals. A valuable starting point may be offering individualized counseling for all physicians.

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Association Between Second Victim Syndrome and Burnout among Physicians at a Single Center
By
Potter, Helen A.; O'Brien-Irr, Monica S.; Henninger, Matthew W.; Flanagan-Priore, Catherine; Winkelstein, Peter; Harris, Linda M.
Source:
Journal of Vascular Surgery

Work environments and practice structural features are associated with both burnout and the ability of practices to enhance quality of care.To characterize factors associated with primary care practices successfully improving quality scores without increasing clinician and staff burnout.This cross-sectional study assessed small- to medium-sized primary care practices that participated in the EvidenceNOW: Advancing Heart Health initiative using surveys that were administered at baseline (September 2015 to April 2017) and after the intervention (January 2017 to October 2018). Data were analyzed from February 2022 to January 2023.The primary outcome of being a quality and well-being positive deviant practice was defined as a practice with a stable or improved percentage of clinicians and staff reporting burnout over the study period and with practice-level improvement in all 3 cardiovascular quality measures: aspirin prescribing, blood pressure control, and smoking cessation counseling.Of 727 practices with complete burnout and aspirin prescribing, blood pressure control, and smoking cessation counseling data, 18.3% (n = 133) met the criteria to be considered quality and well-being positive deviant practices. In analyses adjusted for practice location, accountable care organization and demonstration project participation, and practice specialty composition, clinician-owned practices had greater odds of being a positive deviant practice (odds ratio, 2.02; 95% CI, 1.16-3.54) than practices owned by a hospital or health system.In this cross-sectional study, clinician-owned practices were more likely to achieve improvements in cardiovascular quality outcomes without increasing staff member burnout than were practices owned by a hospital or health system. Given increasing health care consolidation, our findings suggest the value of studying cultural features of clinician-owned practices that may be associated with positive quality and experience outcomes.

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Publicly Available
Association of Clinician Practice Ownership With Ability of Primary Care Practices to Improve Quality Without Increasing Burnout
By
Rotenstein, Lisa S.; Cohen, Deborah J.; Marino, Miguel; Bates, David W.; Edwards, Samuel T.
Source:
JAMA Health Forum

BACKGROUND AND OBJECTIVES: Clinician workload is a key contributor to burnout and well-being as well as overtime and staff shortages, particularly in the primary care setting. Appointment volume is primarily driven by the size of patient panels assigned to clinicians. Thus, finding the most appropriate panel size for each clinician is essential to optimization of patient care. METHODS: One year of appointment and panel data from the Department of Family Medicine were used to model the optimal panel size. The data consisted of 82 881 patients and 105 clinicians. This optimization-based modeling approach determines the panel size that maximizes clinician capacity while distributing heterogeneous appointment types among clinician groups with respect to their panel management time (PMT), which is the percent of clinic work. RESULTS: The differences between consecutive PMT physician groups in total annual appointment volumes per clinician for the current practice range from 176 to 348. The optimization-based approach for the same PMT physician group results in having a range from 211 to 232 appointments, a relative reduction in variability of 88%. Similar workload balance gains are also observed for advanced practice clinicians and resident groups. These results show that the proposed approach significantly improves both patient and appointment workloads distributed among clinician groups. CONCLUSION: Appropriate panel size has valuable implications for clinician well-being, patients' timely access to care, clinic and health system productivity, and the quality of care delivered. Results demonstrate substantial improvements with respect to balancing appointment workload across clinician types through strategic use of an optimization-based approach.

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Publicly Available
Balancing Clinician Workload Through Strategic Patient Panel Designs
By
Huang, Yu-Li; Berg, Bjorn P.; Horn, Jennifer L.; Nagaraju, Darshan; Rushlow, David R.
Source:
Quality Management in Health Care

Limited research has examined what factors serve as potential barriers and motivators for law enforcement personnel in seeking mental health support. The current study presents findings from a survey of 158 sworn and civilian personnel from a large Southeastern Sheriff's office to shed light on these potential barriers/motivators. We drew on previous literature to create measures related to mental health stigma, confidentiality, burnout, various stressors, and organizational support, among others. The main effects OLS regression models suggest that increased perceptions of stigma and personal stressors significantly lowered employees' willingness to seek mental health support. However, increased burnout and job satisfaction were associated with employees seeking mental health support. Multiplicative models show that as job satisfaction increased within nonwhite respondents, those respondents were significantly more likely to seek mental health assistance. However, as personal stressors increased among nonwhite respondents, those respondents were significantly less likely to seek help. Finally, as overall health increased among white respondents, those respondents were significantly more likely to seek help. Findings indicate that mental health issues experienced by employees vary based on group membership. We discuss several future research directions and policy implications derived from these findings.

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Publicly Available
Barriers and Motivators to Seeking Mental Health Support: An Assessment of a Southeastern Sheriff's Office
By
Huynh, Carol M.; Boehme, Hunter M.; Lytle, Daniel
Source:
Criminal Justice Review

[This is an excerpt.] When the coronavirus pandemic hit North America in March of 2020 the medical profession was plunged into a crisis more devastating than any it had faced in the previous century. Trainees and physicians were called to the frontlines to care for extremely ill patients for long hours in the context of inadequate knowledge, skills, and equipment; patients were dying without loved ones to hold their hands and ease their passage. Ethical dilemmas around distribution of limited resources permeated each medical decision and led to moral injury for providers who could not deliver the quality of care that was standard just weeks prior. Healthcare professional burnout and suicide increased from the already significant pre-pandemic rates.1 Many medical schools limited students to virtual learning to protect them from exposure to the virus; yet a byproduct of this prudent decision was that many students found themselves isolated from peers and teachers, and in living situations suboptimal for class attendance and studying. Some questioned whether they were getting an education that would allow them to become good doctors. [To read more, click View Resource.]

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Publicly Available
Bearing Witness: Storytelling by Healthcare Professionals and Learners During Times of Uncertainty
By
Howley, Lisa; Bush, Virginia; Gaufberg, Elizabeth
Source:
Reflective MedEd

When the World Health Organization announced a global pandemic in March of 2020, health care workers across the globe selflessly and tirelessly stood at the frontline. In addition to the clinical challenges an unknown virus brought forth, health care workers were not prepared for the emotional drain and mental health impact. The health care industry is increasingly facing a crisis as frontline workers experience moral distress, emotional trauma, and burnout in high stress health care environments. Debriefing, defined as facilitated interprofessional team reflection after a clinical event, has been shown to improve clinicians’ ability to manage their grief and is associated with lower burnout. A standardized program workshop and intervention, branded as Project Debriefing Event for Analysis and Recovery (D.E.A.R.), was piloted at a pediatric hospital with a multidisciplinary team. These volunteers served as champions to facilitate debriefings following stressful clinical events. The program included education sessions, integration of a standardized debriefing program, and additional resources. Impact of the workshop and educational intervention was evaluated using a pre–post survey design. Data demonstrated increased comfort for the interprofessional facilitators who provided the standardized debriefing. Participants found the sessions highlighted strengths and areas for opportunity. Champions and participants agreed the standardized process improved their emotional wellbeing. Future quality improvement projects are encouraged to standardize debriefing processes addressing the increased need for support to clinicians after a critical incident has occurred.

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Publicly Available
Beating Burnout with Project D.E.A.R.: Debriefing Event for Analysis and Recovery
By
Sandoval, Jasmine B.; Hooshmand, Mary; Sarik, Danielle Altares
Source:
Nurse Leader

BACKGROUND: The concept of a ‘black cloud’ is a common unfounded perception in the healthcare workforce that attributes a heavier workload to specific individuals or teams. Prior studies in non-surgical disciplines have demonstrated that ‘black cloud’ perceptions are not associated with workload, albeit such perceptions may influence behavior. The influence of ‘black cloud’ perceptions on surgical resident workload and burnout remains to be investigated. This study assesses the associations between ‘black cloud’ self-perception with actual workload and burnout among surgical residents in different specialties. METHODS: A cross-sectional survey study of postgraduate year (PGY) 2 and 3 residents enrolled in different surgical residencies at the Icahn School of Medicine at Mount Sinai was conducted between September–November 2021. RESULTS: The survey response rate was 62.1% (41/66). 46.3% of respondents were female. The majority of subjects were single (61%) and PGY2 trainees (56.1%). In a multivariate regression analysis demographic factors and workload variables, such as the number of pages responded, notes, and amount of sleep, were not significant predictors of a ‘black cloud’-self-perception. A significantly lower Burnout Index Score (BIS) was observed among females (p< .001). A significantly higher BIS was observed among residents who are single (p = .003), training in general surgery (p = .02), and orthopedic surgery (p = .03). There was no significant association between ‘black cloud’ self-perception and BIS. DISCUSSION: The findings demonstrate that a ‘black cloud’ self-perception is not associated with a high workload and burnout among surgical residents. Gender, marriage/domestic partnership, and certain surgical specialties influenced burnout among the study cohort.

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Black Clouds in Surgery: A Study of Surgical Resident Workload and Burnout
By
Asfaw, Zerubabbel K.; Schupper, Alexander J.; Durbin, John; Kellner, Christopher; Shrivastava, Raj
Source:
The Surgeon

BACKGROUND: Emergency Medicine has a high rate of physician burnout. Studies have shown that exercise and social activities have positive impacts on physician wellness. Many residency programs have implemented initiatives aimed to positively impact the emotional, physical, intellectual, and social aspects of wellness. OBJECTIVES: The purpose was to improve EM physician wellness by implementing a voluntary team exercise competition into an EM residency program wellness curriculum over 3 months. METHODS: This study utilized a voluntary survey to compare wellness pre- and post-competition. The population studied included 33 EM residents and 28 EM attending participants. Residents were grouped based on pre-established residency “Houses” and attendings assigned to one of these Houses at random. Participants earned 1 point for every 30 minutes of exercise with the winning team earning a residency funded “House Party” at the end of the 3-month period. Data from the survey was analyzed using a 2 Sample T-Test to assess for significance. The mean values of the pre/post data were compared to determine if an aim of 25% improvement in wellness was met. RESULTS: Resident survey results showed that 100% exercised more during this competition and 100% would participate again. There was improvement in wellbeing (p = 0.026), energy (p = 0.014), and sleep (p = 0.025); these areas all also met the aim of improving by more than 25% after this 3-month competition (25%, 36%, 33% respectively). 80% of residents felt that their increased exercise positively impacted their wellness at work. CONCLUSIONS: EM residents had improvement in wellness, energy, and sleep after implementing a team exercise competition. A majority of participants felt this competition encouraged an increase in their exercise and stated they would participate again. Limitations include confounding variables impacting wellness such as changing weather or rotations, low survey response rate, and survey type.

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Publicly Available
Blood, Sweat, and Beers – Improving the Wellness of Emergency Medicine Physicians via Exercise Competition
By
Anderson, Megan; Corbo, Sam; Swisher, Loice
Source:
Western Journal of Emergency Medicine

BACKGROUND: Hospitals and healthcare systems strive to meet benchmarks for the National Database of Nursing Quality Indicator (NDNQI) measures, Centers for Medicare & Medicaid Services (CMS) Core Measures, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) outcome indicators. Prior research indicates that Chief Nursing Officers and Executives (CNOs, CNEs) believe that evidence-based practice (EBP) is important for ensuring the quality of care, but they allocate little funding to its implementation and report it as a low priority in their healthcare system. It is not known how EBP budget investment by chief nurses affects NDNQI, CMS Core Measures, and HCAHPS indicators or key EBP attributes and nurse outcomes. AIMS: This study aimed to generate evidence on the relationships among the budget devoted to EBP by chief nurses and its impact on key patient and nurse outcomes along with EBP attributes. METHODS: A descriptive correlational design was used. An online survey was sent to CNO and CNE members (N = 5026) of various national and regional nurse leader professional organizations across the United States in two recruitment rounds. Data collected included CNO/CNE EBP Beliefs, EBP Implementation, and perceived organizational culture of EBP; organizational culture, structure, personnel, and resources for EBP; percent of budget dedicated to EBP; key performance measures (NDNQI, CMS Core Measures, HCAHPS); nurse satisfaction; nurse turnover; and demographic questions. Descriptive statistics were used to summarize sample characteristics. Kendall's Tau correlation coefficients were calculated among EBP budget, nursing outcome measures, and EBP measures. RESULTS: One hundred and fifteen CNEs/CNOs completed the survey (a 2.3% response rate). The majority (60.9%) allocated <5% of their budget to EBP, with a third investing none. An increase in EBP budget was associated with fewer patient falls and trauma, less nursing turnover, and stronger EBP culture and other positive EBP attributes. A greater number of EBP projects were also associated with better patient outcomes. LINKING EVIDENCE TO ACTION: Chief nurse executives and CNOs allocate very little of their budgets to EBP. When CNEs and CNOs invest more in EBP, patient, nursing, and EBP outcomes improve. System-wide implementation of EBP, which includes appropriate EBP budget allocation, is necessary for improvements in hospital quality indicators and nursing turnover.

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Budgetary Investment in Evidence-Based Practice by Chief Nurses and Stronger EBP Cultures are Associated with Less Turnover and Better Patient Outcomes
By
Melnyk, Bernadette Mazurek; Hsieh, Andreanna Pavan; Messinger, Jeffery; Thomas, Bindu; Connor, Linda; Gallagher-Ford, Lynn
Source:
Worldviews on Evidence-Based Nursing

BACKGROUND: Burn-out is a long-standing problem among healthcare workers (HCWs) and leads to poorer quality and less safe patient care, lower patient satisfaction, absenteeism and reduced workforce retention. Crises such as the pandemic not only generate new challenges but also intensify existing workplace stresses and chronic workforce shortages. As the COVID-19 pandemic continues, the global health workforce is burnt-out and under immense pressure, with multiple individual, organisational and healthcare system drivers. METHOD: In this article, we examine how key organisational and leadership approaches can facilitate mental health support for HCWs and identify strategies to support HCWs that are critical for supporting workforce well-being during the pandemic. RESULTS: We identified 12 key approaches at the organisational and individual levels for healthcare leadership to support workforce well-being during the COVID-19 crisis. These approaches may inform leadership responses to future crises. CONCLUSION: Governments, healthcare organisations and leaders must invest and deliver long-term measures to value, support and retain the health workforce to preserve high-quality healthcare.

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Publicly Available
Burn-Out in the Health Workforce During the COVID-19 Pandemic: Opportunities for Workplace and Leadership Approaches to Improve Well-Being
By
Smallwood, Natasha; Bismark, Marie; Willis, Karen
Source:
BMJ Leader

Burnout is a phenomenon characterized by high emotional exhaustion—feelings of energy depletion, high depersonalization (i.e., cynicism) and detachment from the job, and loss of professional efficacy—sense of ineffectiveness and lack of accomplishment. In fact, it has received a certain kind of official imprimatur by having its own ICD-10 code and now it is considered a “syndrome,” although it is not classified as a medical condition. In the ICD-11 classification, burnout appears in the section on problems related to employment or unemployment. Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition. It has to be related to the occupational context, but it’s not just fatigue or even emotional drain that follows a busy night on call, especially when you know all you need is a good night’s sleep. It is also not depression.

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Publicly Available
Burnout
By
Aron, David C.
Source:
An Insider’s Guide to Academic Medicine: A Clinical Teacher’s Perspective

Physician burnout is increasing in prevalence and has negative implications for the quality of patient care and the health and wellbeing of physicians. Surveys before the COVID-19 pandemic showed high rates of burnout among breast radiologists, and the COVID-19 pandemic has further increased stress. This article summarizes strategies to combat burnout, including improving individual resilience by increasing mindfulness about handling stress, making goals, and noting personal accomplishments. However, more effective change is likely to occur when there is change at both a personal and an organizational level, which includes identifying the stakeholders in a workplace and determining what changes must occur to increase joy and decrease rates of burnout. Despite the increasing rates of burnout, breast radiologists report high rates of personal career satisfaction. Self-reflection and positive steps to increase joy at work are important in maintaining career fulfillment in these challenging times.

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Publicly Available
Burnout Among Breast Radiologists: How Can We Restore Fulfillment?
By
Dwan, Dennis; Dialani, Vandana
Source:
Journal of Breast Imaging

OBJECTIVE: Long-term changes in burnout and its predictors in hospital staff during the COVID-19 pandemic were investigated in an international study. METHODS: Two online surveys were distributed to hospital staff in seven countries (Germany, Andorra, Ireland, Spain, Italy, Romania, Iran) between May and October 2020 (T1) and between February and April 2021 (T2), using the following variables: Burnout (emotional exhaustion and depersonalization), job function, age, gender, and contact with COVID-19 patients; individual resources (self-compassion, sense of coherence, social support) and work-related resources and demands (support at the workplace, risk perception, health and safety at the workplace, altruistic acceptance of risk). Data were analyzed using linear mixed models repeated measures, controlled for age. RESULTS: A total of 612 respondents were included (76% women). We found an increase in burnout from T1 to T2. Burnout was high among personnel with high contact with COVID-19 patients. Individual factors (self-compassion, sense of coherence) and work-related factors (support at the workplace, risk perception, health and safety at the workplace) showed associations with burnout. Low health and safety at the workplace at T1 was associated with an increase in emotional exhaustion at T2. Men showed an increase in depersonalization if they had much contact with COVID-19 patients. CONCLUSION: Burnout represents a potential problematic consequence of occupational contact with COVID-19 patients. Special attention should be paid to this group in organizational health management. Self-compassion, sense of coherence, support at the workplace, risk perception, and health and safety at the workplace may be important starting points for interventions.

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Publicly Available
Burnout Among Hospital Staff During the COVID-19 Pandemic: Longitudinal Results from the International Cope-Corona Survey Study
By
Müller, Markus M.; Baillès, Eva; Blanch, Jordi; Torres, Xavier; Rousaud, Araceli; Cañizares, Silvia; Cervera Teruel, Marta; Conti, Chiara; Dunne, Pádraic J.; Stanculete, Mihaela Fadgyas; Farré, Josep Maria; Font, Elena; Gayán, Elena; Guagnano, Maria Teresa; König, Sarah; Kundinger, Nina; Lanzara, Roberta; Lobo, Antonio; Nejatisafa, Ali-Akbar; Obach, Amadeu; Offiah, Gozie; Peri, Josep Maria; Rosa, Ilenia; Schuster, Sara Katharina; Waller, Christiane; Stein, Barbara
Source:
Journal of Psychosomatic Research

[This is an excerpt.] As a professor at a school of nursing, I have responded to numerous inquiries from my former students who are interested in changing positions, transferring to nonpatient care areas, or seeking work outside the profession of nursing altogether. They describe relentless demands that exceed their tolerance for occupational stress and report being tired and feeling hopeless as they struggle to cope with the protracted effects of the pandemic and challenges in the workplace. They are concerned about their own physical and mental well-being and fear that their professional obligation to provide quality care is in jeopardy. These distressing personal reports from new graduates in their formative years of training are consistent with recent national reports from media outlets that alert readers to the patient safety risks related to deteriorating working conditions in hospitals and a clinical workforce that is suffering from burnout and on the edge of collapse. What began as a call to duty for U.S. health care professionals to respond to a global emergency has resulted in a parallel pandemic of burnout with personal consequences, job disruptions, and potential risk to patients because of compromised quality of care. [To read more, click View Resource.]

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Burnout Among Nurses and Midwives Is a Threat to Maternal and Newborn Health
By
Edmonds, Joyce K.
Source:
Journal of Obstetric, Gynecologic & Neonatal Nursing

Psychiatry residency training includes unique characteristics that can predispose trainees to burnout, including vicarious traumatization, prevalence of patient suicide and violence in the workplace, and social stigma surrounding mental health. For the purposes of this article, the authors examine these contributing factors and address how psychiatry residency training programs, specifically the Kaiser Permanente Oakland program, are responding to these unique challenges with wellness initiatives. Initiatives to promote wellness at Kaiser Permanente Oakland include a resident and faculty–led wellness committee, work-hour limits, reasonable call schedules, a robust mentorship program, funded social and networking events programs, and comprehensive mental health services.

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Burnout Among Psychiatry Residents and One Program’s Approach to Creating a Culture of Wellness
By
Brown, Kathryn H; Bal, Berneen; Plauche, Jessica L; Sung, Dawn; Hirschtritt, Matthew E
Source:
The Permanente Journal

PURPOSE OF REVIEW: To craft an approach to thwart early triggers of symptoms on the burnout continuum for trauma surgeons based on an understanding of drivers of burnout, second victim syndrome, peer-to-peer support, and trauma-informed care. RECENT FINDINGS: Trauma surgeons are particularly vulnerable to risk factors of burnout such as work–life imbalance, higher risk of adverse events, and more exposure to emotionally distressing work events such as witnessing abuse, neglect, and high rates of death among younger patients. Evidence supports the benefit of peer support for the personality style of physicians who often feel unable to show vulnerability as leaders of medical teams. Trauma-informed care allows for optimizing interventions by minimizing triggers from prior distressing events. SUMMARY: An ABCDE (Acknowledge; Bear Witness; Offer Coping Support; Debrief; Enlighten, Engage, and Educate) algorithm for surgeons is an early first step in ameliorating the triggers on the continuum of burnout.

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Burnout Continuum, Recognizing Burnout in the Trauma Provider, Staging It, Intervening Early: Applying ATLS Principles to the Trauma Provider
By
Narayanan, Ragavan; Hassan, Ihab El; Santry, Heena P.
Source:
Current Trauma Reports

BACKGROUND AND OBJECTIVE: The Pediatric Resident Burnout and Resilience Consortium (PRB-RSC) has described the epidemiology of burnout in pediatric residents since 2016. We hypothesized burnout rates during the pandemic would increase. We explored resident burnout during the COVID-19 pandemic and its relationship to resident perception of workload, training, personal life, and local COVID burden. METHODS: Since 2016, PRB-RSC has sent an annual, confidential survey to over 30 pediatric and medicine-pediatrics residencies. In 2020 and 2021, seven questions were added to explore the relationship of COVID-19 and perceptions of workload, training, and personal life. RESULTS: In 2019, 46 programs participated, 22 in 2020, and 45 in 2021. Response rates in 2020 (n = 1055, 68%) and 2021(n = 1702, 55%) were similar to those of previous years (P = .09). Burnout rates in 2020 were significantly lower than in 2019 (54% vs 66%, P < .001) but returned to pre-COVID levels in 2021 (65%, P = .90). In combined 2020–2021 data, higher rates of burnout were associated with reported increased workload (Adjusted Odds Ratio (AOR) 1.38, 95% CI 1.19–1.6) and concerns regarding the effect of COVID on training (AOR 1.35, 95% CI 1.2–1.53). Program-level county COVID burden in combined 2020–2021 data was not associated with burnout in this model (AOR = 1.03, 95% CI 0.70–1.52). CONCLUSIONS: Burnout rates within reporting programs decreased significantly in 2020 and returned to prepandemic levels in 2021. Increased burnout was associated with perceived increases in workload and concerns regarding effect of the pandemic on training. Given these findings, programs should consider further investigation into workload and training uncertainty on burnout.

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Burnout During the COVID-19 Pandemic: A Report on Pediatric Residents
By
Zuniga, Linessa M.; Schuh, Abigail; Schwartz, Alan; Seo-Mayer, Patricia; Cramton, Rachel; Sieplinga, Kira; Kaushik, Ruchi; Nassetta, Lauren; Homme, Jason H.; Babal, Jessica; Mahan, John D.; Batra, Maneesh
Source:
Academic Pediatrics

CONTEXT: Physicians face a high rate of burnout, especially during the residency training period when trainees often experience a rapid increase in professional responsibilities and expectations. Effective burnout prevention programs for resident physicians are needed to address this significant issue. OBJECTIVE: To examine the content, format, and effectiveness of resident burnout interventions published in the last 10 years. DESIGN: The literature search was conducted on the MEDLINE database with the following keywords: internship, residency, health promotion, wellness, occupational stress, burnout, program evaluation, and program. Only studies published in English between 2010 and 2020 were included. Exclusion criteria were studies on interventions related to the COVID-19 pandemic, studies on duty hour restrictions, and studies without assessment of resident well-being postintervention. RESULTS: Thirty studies were included, with 2 randomized controlled trials, 3 case-control studies, 20 pretest and posttest studies, and 5 case reports. Of the 23 studies that used a validated well-being assessment tool, 10 reported improvements postintervention. These effective burnout interventions were longitudinal and included wellness training (7 of 10), physical activities (4 of 10), healthy dietary habits (2 of 10), social activities (1 of 10), formal mentorship programs (1 of 10), and health checkups (1 of 10). Combinations of burnout interventions, low numbers of program participants with high dropout rates, lack of a control group, and lack of standardized well-being assessment are the limitations identified. CONCLUSIONS: Longitudinal wellness training and other interventions appear effective in reducing resident burnout. However, the validity and generalizability of the results are limited by the study designs.

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Burnout Interventions for Resident Physicians: A Scoping Review of Their Content, Format, and Effectiveness
By
Lu, Fang-I; Ratnapalan, Savithiri
Source:
Archives of Pathology & Laboratory Medicine

AIMS AND OBJECTIVE: To identify the prevalence and severity of impostor phenomenon and burnout in newly licensed registered nurses, map the current literature on impostor phenomenon in nursing, and identify related factors affecting the new nurse's transition to practice. BACKGROUND: Impostor phenomenon is an internalised intellectual phoniness resulting in persistent self-doubt despite prior success. It can evoke feelings of emotional exhaustion associated with burnout, negatively affecting employee retention. Due to changes in nursing education resulting from COVID-19, self-doubt and uncertainty among new nurses are expected to be heightened, leading to burnout which adversely effects nurse well-being, patient care and retention. DESIGN: The scoping review follows the methodological framework developed by Arksey and O'Malley (2005) and the Reporting Checklist for Scoping Reviews (PRISMA-ScR) guidelines. METHODS: The literature search was conducted utilising PubMed, CINAHL and PsycINFO. Inclusion criteria were studies published between 2011 and 2021, written in English, peer-reviewed, and focused on newly licensed registered nurses. Eighteen articles were reviewed. RESULTS: Studies on impostor phenomenon in nursing are limited to nursing students and clinical nurse specialists. Prevalence of impostor feelings in these populations range from 36% to 75%, and 12.3% to 46% of new nurses report burnout. Impostor feelings arise from role ambiguity, lack of self-compassion, transitions, and minimal clinical experience. Burnout was associated with stress, feeling unprepared, inadequate socialisation, and lack of self-compassion. Overlap in these factors could increase impostor feelings and burnout in new nurses. CONCLUSIONS: Effects of impostor phenomenon and burnout can negatively impact the well-being of the new nurse. Currently, no studies simultaneously examine impostor phenomenon and burnout in new nurses. Further research on the relationship between these phenomena should be conducted. RELEVANCE TO CLINICAL PRACTICE: Understanding the impact of impostor phenomenon and burnout on new nurses could help mitigate challenges they face transitioning into practice.

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Burnout and Impostor Phenomenon in Nursing and Newly Licensed Registered Nurses: A Scoping Review
By
Edwards-Maddox, Shermel
Source:
Journal of Clinical Nursing

OBJECTIVE: Burnout has detrimental consequences for health care organizations, clinicians, and the quality of care that patients receive. Prior work suggests that workplace incivility (negative interpersonal acts) contributes to burnout. While workplace incivility is linked to EMS practitioner job dissatisfaction, absenteeism, and planned attrition, the relationship between workplace incivility and burnout has not been evaluated among EMS practitioners. This study aimed to characterize the prevalence and association of burnout and workplace incivility among EMS practitioners. METHODS: A cross-sectional survey of EMS personnel in King County, Washington was performed in January to March of 2021 with burnout as the primary outcome and workplace incivility as a secondary outcome. Multivariable logistic regression was used to evaluate associations between outcomes and EMS practitioner factors that included age, sex, race/ethnicity, years of EMS experience, and current job role. RESULTS: 835 completed surveys were received (response rate 25%). The prevalence of burnout was 39.2%. Women were more likely to have burnout than men (59.3% vs. 33.7%, aOR 2.2, 95% CI 1.3–3.7). Workplace incivility was experienced weekly by 32.1% of respondents, with women more likely to experience incivility compared to men (41.9% vs. 27.2%, aOR 2.0, 95% CI 1.2–3.3). Respondents who experienced frequent workplace incivility were more likely to have burnout than those who did not experience frequent incivility (61.9% vs. 38.1%, OR 4.0, 95% CI 3.0–5.5). CONCLUSIONS: The prevalence of burnout and workplace incivility were concerning among EMS practitioners, with women more likely to experience both compared to men. EMS practitioners who experienced frequent workplace incivility were also more likely to have burnout than those who did not experience frequent incivility.

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Burnout and Workplace Incivility Among Emergency Medical Services Practitioners: A Preliminary Report
By
Lu, Dave W.; Shin, Jenny; Wan, Christopher; Rea, Thomas D.; Crowe, Remle P.; Meischke, Hendrika W.; Counts, Catherine R.
Source:
Prehospital Emergency Care

Burnout is a feeling of exhaustion that leads to negative effects for those experiencing it. These feelings of exhaustion and depersonalization are common in social workers, and were only exacerbated by the Covid-19 pandemic. Feelings of burnout can lead to health problems for the social worker, and increased odds of a negative outcome for their clients. This study aimed to answer the question: does the average Masters of Social Work (MSW) student experience burnout? Using the Maslach Burnout Inventory for students, 36 respondents were found, on average, to not be suffering from burnout. One limitation of this study may be its small sample size. Implications of these findings are discussed.

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Burnout in MSW Students
By
Kremmel, Edward
Source:
Southern Connecticut State University ProQuest Dissertations Publishing

[This is an excerpt.] In the last decade, there has been a heightened awareness of burnout in medicine, particularly in medical education. It has garnered further attention during the COVID-19 pandemic, with healthcare workers facing a tremendous amount of pressure to care for patients with an unknown illness, while working long hours in personal protective equipment and putting themselves and their families at risk. Similarly, the pandemic precipitated burnout in medical students as many started and completed their clinical rotations during the height of the pandemic, all while preparing and applying for residency. While the pandemic may have accentuated the issues faced by healthcare workers and medical students and brought public attention to them, the concept of burnout remains unclear and difficult to define despite being referenced on a regular basis. [To read more, click View Resource.]

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Burnout in Medical School: A Medical Student's Perspective
By
Morcos, George; Awan, Omer A.
Source:
Academic Radiology

AIM: To reflect on how characteristics inherent in the nursing profession might be related to burnout syndrome among the nursing collective. BACKGROUND: Most people are unaware of the tasks and responsibilities of the nursing profession, as well as the burnout rates suffered by nurses. The nursing profession is a feminized profession, and this feminization may lead to the assignment of gender stereotypes and roles traditionally attributed to women. Much of the care provided by nurses is unrecorded, “invisible” and could be seen as an extension of their role as caregivers. METHODS: This is a discussion paper. The literature on gender stereotypes, unrecorded (invisible) care in nursing and burnout are the argumentative basis of this work. DISCUSSION: Stereotypes and gender roles may explain the lack of recognition of some of the carework carried out by nurses. Care, which is the essence of the profession, continues to be largely invisible and is not valued. This lack of recognition of invisible care, coupled with gender stereotypes, may help to understand burnout syndrome in nursing. Impact for Nursing: Health organizations should take into account the history of the nursing profession and the stereotypes associated with it. It is necessary to recognize and make visible much of the care provided by nurses which are not recorded (invisible care), since this would facilitate the visibilization of the workload and could reduce the possibility of suffering burnout. If we want quality care and staff who enjoy the greatest possible well-being, it will be necessary to take these variables into consideration. One purpose should be: to care for them so that they can provide quality care to others. No Patient or Public Contribution This is a discussion paper.

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Burnout in Nursing: A Vision of Gender and “Invisible” Unrecorded Care
By
Montañés Muro, Mª Pilar; Ayala Calvo, Juan Carlos; Manzano García, Guadalupe
Source:
Journal of Advanced Nursing

BACKGROUND: The authors sought to identify the prevalence of burnout in oral medicine (OM) and orofacial pain (OFP) residents and investigate potential contributing factors. METHODS: A cross-sectional questionnaire-based study was conducted. An anonymous 22-item online survey was emailed to the residents of all Commission on Dental Accreditation–accredited OM and OFP residency programs in the United States. Abbreviated Maslach Burnout Inventory was included to gauge the following details of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment. Questions also addressed the impact of residency program characteristics, work-life balance, and possible discrimination or abuse on burnout. RESULTS: Six OM and 12 OFP programs (72 residents) were contacted, and 46 residents responded (response rate, 64%). Overall prevalence of burnout was 35% (29% in OM residents, 40% in OFP residents). High EE burnout was noted in 57% of residents, high DP burnout in 11% of residents, and high personal accomplishment burnout in 59% of residents. Working for fewer than 40 hours per week was significantly associated with low DP burnout (P < .05). Moderate to high DP burnout was more prevalent in men and unmarried residents (whether in a relationship or not) were more likely to experience moderate to high EE burnout (P < .05). CONCLUSIONS: Burnout among OM and OFP residents is an emerging concern due to its detrimental effect on the physical and mental well-being of the residents. To the authors’ knowledge, this study is the first to report burnout prevalence in the 2 most recent dental specialties recognized by the American Dental Association in 2020. Practical Implications Early detection of signs of burnout among residents would allow program faculty and administrators to provide required support and resources.

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Burnout in Oral Medicine and Orofacial Pain Residents
By
Sandhu, Shaiba; Alsafwani, Zahra; Sankar, Vidya; Handa, Shruti; Villa, Alessandro
Source:
The Journal of the American Dental Association

This commentary, compiled by the EPA-UNEPSA social pediatrics working group in collaboration with the European Confederation of Primary Care Pediatricians (ECPCP) and the Italian Federation of Primary Care Pediatricians (FIMP), briefly discusses the growing frequency of burnout in primary care and in primary care pediatrics, and debates how to reduce the risk of burnout and mitigate stress caused by this condition.

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Burnout in Primary Care Pediatrics and the Additional Burden from the COVID-19 Pandemic
By
Nigri, Luigi; Carrasco-Sanz, Angel; Pop, Tudor Lucian; Giardino, Ida; Vural, Mehmet; Ferrara, Pietro; Indrio, Flavia; Pettoello-Mantovani, Massimo
Source:
The Journal of Pediatrics

Burnout is prevalent throughout medicine. Few large-scale studies have examined the impact of physician compensation or clinical support staff on burnout among hematologists and oncologists. In 2019, the American Society of Hematology conducted a practice survey of hematologists and oncologists in the AMA (American Medical Association) Masterfile; burnout was measured using a validated, single-item burnout instrument from the Physician Work-Life Study, while satisfaction was assessed in several domains using a 5-point Likert scale. The overall survey response rate was 25.2% (n = 631). Of 411 respondents with complete responses in the final analysis, 36.7% (n = 151) were from academic practices and 63.3% (n = 260) from community practices; 29.0% (n = 119) were female. Over one-third (36.5%; n = 150) reported burnout, while 12.0% (n = 50) had a high level of burnout. In weighted multivariate logistic regression models incorporating numerous variables, compensation plans based entirely on relative value unit (RVU) generation were significantly associated with high burnout among academic and community physicians, while the combination of RVU + salary compensation showed no significant association. Female gender was associated with high burnout among academic physicians. High advanced practice provider utilization was inversely associated with high burnout among community physicians. Distinct patterns of career dissatisfaction were observed between academic and community physicians. We propose that the implementation of compensation models not based entirely on clinical productivity increased support for women in academic medicine, and expansion of advanced practice provider support in community practices may address burnout among hematologists and oncologists.

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Burnout in US Hematologists and Oncologists: Impact of Compensation Models and Advanced Practice Provider Support
By
Lee, Alfred Ian; Masselink, Leah E.; De Castro, Laura M.; Marshall, Ariela L.; Connell, Nathan T.; Dent, Georgette A.; Fritz, Josel; Homer, Morgan; Lucas, Tiffany L.; Naik, Rakhi P.; Nelson, Marquita; O�Connell, Casey L.; Rajasekhar, Anita; Reynolds, Robby J.; Sharma, Deva; Smith, Melody; Weeks, Lachelle D.; Erikson, Clese E.
Source:
Blood Advances

Workplace related burnout is rampant in medicine. Prevalence is even higher in surgical specialties, higher during various stages of training, and higher still in women in these specialties. There has been a concerted effort by various deliberative bodies to institute policies to combat this. Efforts at institutional levels as well as community levels are encouraged. Some guidelines about techniques individuals can use have been reviewed recently in literature, i.e., resilience training, actively seeking mentorship, advocating for time for self-care, attention to medical needs etc. However, most of the published literature tackles different singular aspects of burnout. For women surgical trainees, we propose a comprehensive approach to tackling burnout. This paper outlines the various causes and the solutions currently in practice and hopes to act as a guide for women surgeons at various stages of their professional lives.

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Burnout in the Women Surgical Trainee; Is It Time to Consider a More Global Approach to Tackle This Issue?
By
Sabih, Quratulain; Cappuccino, Helen; Edge, Stephen; Takabe, Kazuaki; Young, Jessica
Source:
Surgery in Practice and Science

This Viewpoint discusses the consequences of physician burnout and offers insights for its prevention.

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Burnout, Professionalism, and the Quality of US Health Care
By
Khullar, Dhruv
Source:
JAMA Health Forum

PURPOSE: We hypothesize burnout has failed to improve and certain demographics may be disproportionately affected. MATERIALS AND METHODS: The AUA Workforce Workgroup examined work from the annual AUA Census over the past several years. Particular to this study, relevant burnout-related data were examined from the past 5 years. RESULTS: In 2021, 36.7% of urologists reported burnout compared to 36.2% in 2016. Burnout in men decreased from 36.3% to 35.2%, but increased in women from 35.3% to 49.2%. When examined by age, the largest increases in burnout were seen in those <45 years old, increasing from 37.9% to 44.8%, followed by 45-54 years old, increasing from 43.4% to 44.6%. When asked about the effect of COVID-19 on burnout, 54% of urologists didn't feel COVID-19 impacted burnout. Beyond burnout, only 25.0% of men and 4.6% of women reported no conflict between work and personal responsibilities, while 25.7% of men and 44.7% of women resolved these conflicts in favor of work or were unable to resolve them. Of respondents, 22.5% of men and 37.1% of women were "dissatisfied" with work-life balance. Similarly, 33.6% of men reported their work schedule does not leave enough time for personal/family life, compared to 57.5% of women. CONCLUSIONS: Overall, urologists have higher burnout now when compared to 2016. The gender discrepancy has vastly widened with women experiencing burnout at an increased rate of 14% compared to 2016, while burnout in men decreased by 1%. Burnout has increased the most in those <45 years old. Further action is needed to substantiate the causes of burnout.

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Burnout: A Call to Action From the AUA Workforce Workgroup
By
Harris, Andrew M.; Teplitsky, Seth; Kraft, Kate H.; Fang, Raymond; Meeks, William; North, Amanda
Source:
The Journal of Urology

[This is an excerpt.] Burnout and the related morale injury it causes are characterized by physical and/or emotional exhaustion, depersonalization, and decreased effectiveness. Burnout is all too common in physicians and is estimated to affect at least 50% of physicians at some point in their career.1 Many systemic risk factors contribute to this epidemic, including high patient volumes, increased administrative burden, lack of "user-friendly" electronic medical records, and lack of organizational infrastructure. Personal risk factors include being female, not having a spouse or partner, and being of younger age. [To read more, click View Resource.]

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Burnout: Which Way Out?
By
Vose, Julie
Source:
Oncology

Through a national survey, researchers identified prevalent work overload, burnout, and intent to leave health care professions among nurses, clinical staff, and non-clinical staff, including housekeeping, administrative staff, lab technicians, and food service workers.

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COVID Burnout Hitting All Levels of Healthcare Workforce
By
Communications, B. W. H.
Source:
Harvard Gazette

INTRODUCTION: Acute care surgeons can experience posttraumatic stress disorder (PTSD) due to the cumulative stress of practice. This study sought to document the potential impact of the COVID-19 pandemic on PTSD in acute care surgeons and to identify potential contributing factors. METHODS: The six-item brief version of the PTSD Checklist-Civilian Version (PCL-6), a validated instrument capturing PTSD symptomology, was used to screen Eastern Association for the Surgery of Trauma members. Added questions gauged pandemic effects on professional and hospital systems-level factors. Regression modeling used responses from attending surgeons that fully completed the PCL-6. RESULTS: Complete responses from 334 of 360 attending surgeons were obtained, with 58 of 334 (17%) screening positive for PTSD symptoms. Factors significantly contributing to both higher PCL-6 scores and meeting criteria for PTSD symptomology included decreasing age, increased administrative duties, reduced research productivity, nonurban practice setting, and loss of annual bonuses. Increasing PCL-6 score was also affected by perceived illness risk and higher odds of PTSD symptomology with elective case cancellation. For most respondents, fear of death and concerns of illness from COVID-19 were not associated with increased odds of PTSD symptomology. CONCLUSIONS: The prevalence of PTSD symptomology in this sample was similar to previous reports using surgeon samples (15%-22%). In the face of the COVID-19 pandemic, stress was not directly related to infectious concerns but rather to the collateral challenges caused by the pandemic and unrelated demographic factors. Understanding factors increasing stress in acute care surgeons is critical as part of pandemic planning and management to reduce burnout and maintain a healthy workforce.

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COVID Stressed, but Not Due to the Virus
By
Valenzuela, Julie Y.; Robitsek, R. Jonathan; James, Melissa K.; McKenzie, Katherine; Esposito, Thomas J.
Source:
The Journal of Surgical Research

OBJECTIVE: The aim of the study is to increase understanding regarding healthcare provider experiences with psychological trauma, moral injury, and institutional betrayal, both over the lifetime and during the COVID-19 pandemic. METHODS: The study employed a cross-sectional design to understand traumatic experiences, moral injury, and institutional betrayal among medical and mental health providers. Participants were asked to identify an index trauma, and experiences were coded qualitatively using categories for traumatic events, moral injury, and institutional betrayal. RESULTS: Results revealed that experiences of trauma, moral injury, and institutional betrayal were common in relation to the pandemic, as were prepandemic histories of traumatic exposures. Findings indicate that trauma exposure was a work hazard for healthcare providers during the pandemic, which could result in negative long-term mental health outcomes. CONCLUSIONS: Future research is needed to explore potential long-term negative outcomes among healthcare providers.

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COVID-19 and Lifetime Experiences of Trauma, Moral Injury, and Institutional Betrayal among Healthcare Providers
By
DeBeer, Bryann B.; Mignogna, Joseph; Nance, Morgan; Bahraini, Nazanin; Penzenik, Molly; Brenner, Lisa A.
Source:
Journal of Occupational & Environmental Medicine

Healthcare workers are highly regarded for their compassion, dedication, and composure. However, COVID-19 created unprecedented demands that rendered healthcare workers vulnerable to increased burnout, anxiety, and depression. This cross-sectional study assessed the psychosocial impact of COVID-19 on U.S. healthcare frontliners using a 38-item online survey administered by Reaction Data between September and December 2020. The survey included five validated scales to assess self-reported burnout (Maslach Summative Burnout Scale), anxiety (GAD-7), depression (PHQ-2), resilience (Brief Resilience Coping Scale), and self-efficacy (New Self-Efficacy Scale-8). We used regression to assess the relationships between demographic variables and the psychosocial scales index scores and found that COVID-19 amplified preexisting burnout (54.8%), anxiety (138.5%), and depression (166.7%), and reduced resilience (5.70%) and self-efficacy (6.5%) among 557 respondents (52.6% male, 47.5% female). High patient volume, extended work hours, staff shortages, and lack of personal protective equipment (PPE) and resources fueled burnout, anxiety, and depression. Respondents were anxious about the indefinite duration of the pandemic/uncertain return to normal (54.8%), were anxious of infecting family (48.3%), and felt conflicted about protecting themselves versus fulfilling their duty to patients (44.3%). Respondents derived strength from their capacity to perform well in tough times (74.15%), emotional support from family/friends (67.2%), and time off work (62.8%). Strategies to promote emotional well-being and job satisfaction can focus on multilevel resilience, safety, and social connectedness.

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COVID-19 and Psychosocial Well-Being: Did COVID-19 Worsen U.S. Frontline Healthcare Workers’ Burnout, Anxiety, and Depression?
By
Novilla, M. Lelinneth B.; Moxley, Victor B. A.; Hanson, Carl L.; Redelfs, Alisha H.; Glenn, Jeffrey; Donoso Naranjo, Paola G.; Smith, Jenna M. S.; Novilla, Lynneth Kirsten B.; Stone, Sarah; Lafitaga, Rachel
Source:
International Journal of Environmental Research and Public Health

In this report and analysis of the results of a late 2021 post-COVID pandemic survey of members of the Society of Thoracic Radiology, we compared cardiothoracic radiologist workloads and burnout rates with those obtained from a prepandemic survey of society members. The more recent survey also asked respondents to provide a subjective assessment of their individual workload capacity should they be required to read cases at a section average daily case work volume, and this assessment was correlated with burnout rates. To measure nonrelative value unit workload, we requested data on non–case-related work responsibilities including teaching and multidisciplinary conferences that were not assessed in the first survey. In addition, we asked respondents to provide information on the availability of support services, personnel, and hardware and software tools that could improve work efficiency and reduce radiologist stress levels thereby mitigating burnout. We found that postpandemic case workload and cardiothoracic radiologists’ burnout rates were similarly high compared with prepandemic levels with an overall burnout rate of 88% including a 100% burnout rate among women which had significantly increased. The range of radiologists’ workload capacity is broad, although 80% of respondents reported that reading at an average sectional case volume was at or above their capacity, and the perceived capacity correlated with burnout measures. The presence of fellows and computer-aided diagnosis/artificial intelligence tools were each associated with significant decreases in burnout, providing 2 potential strategies that could be employed to address high cardiothoracic radiologist burnout rates.

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Cardiothoracic Radiologist Workload, Work Capacity, and Burnout Post-COVID: Results of a Survey From the Society of Thoracic Radiology
By
Meyer, Cristopher A.; Klein, Jeffrey S.; Liubauskas, Rokas; Bhalla, Sanjeev; Eisenberg, Ronald L.
Source:
Journal of Thoracic Imaging

Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge—rooted in the philosophy of care—is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.

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Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper
By
Brune, Sara; Killam, Laura; Camargo-Plazas, Pilar
Source:
Issues in Mental Health Nursing

AIMS: To synthesize the empirical and theoretical literature on change fatigue in nursing, including how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it. BACKGROUND: Change fatigue refers to the overwhelming feelings of stress, exhaustion and burnout associated with rapid and continuous change across healthcare organizations. Change fatigue can affect nurses' wellbeing, yet there is a distinct lack of literature which synthesizes the relationship between cumulative organizational change and nurses' wellbeing. DESIGN: Integrative review following Toronto and Remington and Whittemore and Knafl methodology. DATA SOURCES: Searches were conducted in CINAHL, Embase, Medline, APA PsycInfo, Scopus, Business Source Complete and ProQuest Dissertations & Theses Global in January 2022. REVIEW METHODS: A comprehensive search was conducted to identify literature on change fatigue in nursing. Included literature were critically appraised for methodological quality. Data from each article were abstracted and thematically analysed. RESULTS: Twenty-six articles were included in this review, including 14 empirical studies, 10 theoretical papers and two literature reviews. Five main themes described in the literature included: definitions, preceding factors, associated behaviours, consequences and mitigation strategies for change fatigue. CONCLUSION: This review highlights the impact of rapid and continuous change on nurses and nursing practice. Further research is needed to explore the relationship between change fatigue and burnout, understand how and why nurses withdraw or avoid change, and to develop a metric to measure change fatigue when considering new change initiatives. IMPACT: Findings from this review generated an improved understanding of how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it. This paper provides practical recommendations for future research, direction for nursing educators and leaders, and encourages nurses to practice political agency with change management.

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Change Fatigue in Nursing: An Integrative Review
By
Beaulieu, Lindsay; Seneviratne, Cydnee; Nowell, Lorelli
Source:
Journal of Advanced Nursing

OBJECTIVES: Electronic health record (EHR) inbox notifications can be burdensome for primary care providers (PCPs), potentially contributing to burnout. We estimated the association between changes in the quantities of EHR inbox notifications and PCP burnout. STUDY DESIGN: In this observational study, we tested the association between the percent change in daily inbox notification volumes and PCP burnout after an initiative to reduce low-value notifications at the Veterans Health Administration (VHA). METHODS: The VHA initiative resulted in increases and decreases in notification volumes for PCPs. For each facility, the proportion of PCPs reporting burnout was estimated using VHA All Employee Survey responses before and after the initiative in 2016 and 2018, respectively. Survey responses were aggregated for 6459 PCPs (physicians, nurse practitioners, and physician assistants) at 138 VHA facilities. Fixed effects regression models estimated the association of small and large increases and small and large decreases in notifications on burnout. RESULTS: Daily inbox notifications per PCP decreased by a mean (SD) of 5.9% (30.1%) across study facilities, from a mean (SD) of 128 (52) notifications to 114 (44) notifications after the initiative. Fifty-one percent of facilities experienced reductions in notifications, 30% experienced no change, and 20% experienced increased notifications. PCP burnout was not significantly associated with any level of increase or decrease in notifications. CONCLUSIONS: Changes in notification volumes alone did not predict PCP burnout. Future research to reduce burnout might still address EHR notification volumes, but as part of a broader set of strategies that consider the other stressors that PCPs experience.

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Publicly Available
Changes in Electronic Notification Volume and Primary Care Provider Burnout
By
O'Connor, Allyson W.; Helfrich, Christian D.; Nelson, Karin M.; Sears, Jeanne M.; Singh, Hardeep; Wong, Edwin S.
Source:
The American Journal of Managed Care

As humanitarian emergencies become increasingly prevalent and protracted, the sustainability and quality of humanitarian aid work are threatened by its staff’s unaddressed occupational stress and mental health problems. While there is accumulating research on psychological and stress-related disorders’ prevalence and risk factors, there is less evidence on empirically supported mental health and psychosocial support (MHPSS) interventions for humanitarian and disaster relief personnel. Existing interventions are primarily reactive rather than preventive, may produce iatrogenic effects, and are poorly implemented. This chapter synthesizes the extant literature and proposes a comprehensive and systematic framework for the promotion of wellbeing, prevention, and management of occupational stress-related mental health and psychosocial problems for this occupational group. Informed by risk and protective factors unique to humanitarian and emergency relief work, the chapter summarizes a broad spectrum of interventions across various deployment and emergency response phases and targeted at the individual staff, managers, team, and organization levels. The chapter recommends organizational-level MHPSS policy and standards of practice; predeployment psychoeducational training; perideployment mental health monitoring and support; manager-specific training; peer support programs; stepped-care crisis intervention and psychological treatment model; and promoting resilience and posttraumatic growth. Specific adaptations for vulnerable demographic groups in this workforce and potential implementation barriers are discussed. The comprehensive, evidence-informed MHPSS intervention framework outlined in this chapter can serve as a blueprint for staff care in humanitarian aid organizations.

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Publicly Available
Chapter 21 - Psychosocial Interventions for Occupational Stress and Psychological Disorders in Humanitarian Aid and Disaster Responders: A Critical Review
By
Foo, Cheryl Yunn Shee; Verdeli, Helen; Tay, Alvin Kuowei
Source:
Handbook of Cognitive Behavioral Therapy by Disorder

A multisite research team proposed a survey to assess burnout among healthcare epidemiologists. Anonymous surveys were disseminated to eligible staff at SRN facilities. Half of the respondents were experiencing burnout. Staffing shortages were a key stressor. Allowing healthcare epidemiologists to provide guidance without directly enforcing policies may improve burnout.

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Publicly Available
Characterizing Burnout among Healthcare Epidemiologists in the Early Phases of the COVID-19 Pandemic: A Study of the SHEA Research Network
By
Smith, Tucker John Guy; Pryor, Rachel; Hota, Susy S.; Haessler, Sarah D.; Deloney, Valerie M.; Bearman, Gonzalo
Source:
Antimicrobial Stewardship & Healthcare Epidemiology

IMPORTANCE: Moral injury and distress (MID), which occurs when individuals have significant dissonance with their belief system and overwhelming feelings of being powerless to do what is believed to be right, has not been explored in the unique population of military surgeons deployed far forward in active combat settings. Deployed military surgeons provide care to both injured soldiers and civilians under command-driven medical rules of engagement (MROE) in variably resourced settings. This practice setting has no civilian corollary for comparison or current specific tool for measurement. OBJECTIVE: To characterize MID among military surgeons deployed during periods of high casualty volumes through a mixed-methods approach. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study using convergent mixed methods was performed from May 2020 to October 2020. Participants included US military surgeons who had combat deployments to a far-forward role 2 treatment facility during predefined peak casualty periods in Iraq (2003-2008) and Afghanistan (2009-2012), as identified by purposeful snowball sampling. Data analysis was performed from October 2020 to May 2021. MAIN OUTCOMES AND MEASURES: Measure of Moral Distress for Healthcare Professionals (MMD-HP) survey and individual, semistructured interviews were conducted to thematic saturation. RESULTS: The total cohort included 20 surgeons (mean [SD] age, 38.1 [5.2] years); 16 (80%) were male, and 16 (80%) had 0 or 1 prior deployment. Deployment locations were Afghanistan (11 surgeons [55%]), Iraq (9 surgeons [45%]), or both locations (3 surgeons [15%]). The mean (SD) MMD-HP score for the surgeons was 104.1 (39.3). The primary thematic domains for MID were distressing outcomes (DO) and MROE. The major subdomains of DO were guilt related to witnessing horrific injuries; treating pregnant women, children, and US soldiers; and second-guessing decisions. The major subdomains for MROE were forced transfer of civilian patients, limited capabilities and resources, inexperience in specialty surgical procedures, and communication with command. Postdeployment manifestations of MID were common and affected sleep, medical practice, and interpersonal relationships. CONCLUSIONS AND RELEVANCE: In this qualitative study, MID was ubiquitous in deployed military surgeons. Thematic observations about MID, specifically concerning the domains of DO and MROE, may represent targets for further study to develop an evaluation tool of MID in this population and inform possible programs for identification and mitigation of MID.

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Publicly Available
Characterizing Moral Injury and Distress in US Military Surgeons Deployed to Far-Forward Combat Environments in Afghanistan and Iraq
By
Ryu, Madeline Y.; Martin, Matthew J.; Jin, Alexander H.; Tabor, Holly K.; Wren, Sherry M.
Source:
JAMA Network Open

Social workers are struggling within their professional and personal lives. Many clinical social workers who work in the mental health and medical field are struggling with poor health behaviors, secondary traumatic stress (STS), depression, anxiety, and burnout due to staff shortages, rapid turnover, compassion fatigue, and poor staff recruitment (Toh et al., 2018). Untreated trauma related to bereavement issues can result in PTSD and complicated grief symptoms in clinical populations when left untreated by a trained mental health clinician (Glad et al., 2022). Social work clinicians can expect therapeutic encounters to include discussions of deaths, loss, and reduced security contributing to negative mental health occurrences as a result of the COVID-19 pandemic. Social workers who work with families and individuals who are experiencing trauma are often adversely affected by these interactions, resulting in negative outcomes for the social worker (Caringi et al., 2017). A recent study of the COVID-19 pandemic and related mental health issues found an increase in anxiety and mental health issues related to stress, grief, fear, and depression (Estes & Thompson, 2020). Many social work clinicians may require mental health treatment of their own COVID-19 experiences, while simultaneously developing vicarious trauma (VT) and countertransference issues as a result of working with a clinical population in the treatment setting.

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Publicly Available
Clinical Crisis: When Your Therapist Needs Therapy!
By
Agpalza, Patsy; Cegelka, Derek
Source:
Health & Social Work

OBJECTIVE: To evaluate feasibility and effectiveness of Clinically Designed Improvisatory Music (CDIM) to reduce work-related stress for Neurology, Psychiatry, and other health professionals. BACKGROUND: Chronic stress characterizes healthcare providers’ lives. Music interventions show reductions in stress in the work setting. Our previous research showed that CDIM reduced cardiovascular burden and feelings of stress and anxiety in neurology patients. In this study, we investigated whether CDIM could also be used for Neurology and Psychiatry health care providers to decrease levels of stress. DESIGN/METHODS: CDIM is a form of clinical music designed along neuropsychiatric principles of felt safety. I was played by a certified music practitioner for 30 minutes. We used CDIM in three settings: 1. Neurology Department, 2. Psychiatric social workers, 3. Physician Recuperation Room located at Northwestern Memorial Hospital. All participants rated their experience on a scale of 1–10 reporting changes in emotions and states pertinent to burnout (likelihood to recommend [LTR], positive emotion, degree of tension, ability to experience pleasure, and energy levels). RESULTS: Four hundred twenty nine (429) healthcare providers took part in CDIM interventions. Participants recommended CDIM at a rate of 93% (+ 9%). They reported positive effects on emotion at 80% (+ 19%), decreased tension at 82% (+ 15%). Eighty percent (80%) found the intervention pleasurable and reported increased levels of energy following CDIM. Changes in energy levels went up from 60% (+ 16%) to to 80% (+ 16%). This latter change was significant at p= 0.0001. CONCLUSIONS: The CDIM interventions resulted in improvements in tension, energy, and of pleasure, which suggest an increase in capacity. These preliminary results indicate feasibility and effectiveness of CDIM as a viable intervention for supporting wellness and fighting burnout. We plan to provide and disseminate CDIM more widely to include more healthcare providers and staff, and to include physiologic measures by using wearable devices. DISCLOSURE: Ms. Takarabe has nothing to disclose. Rajan Shah has nothing to disclose. Mrs. Walesa has nothing to disclose. Miss Ngo has nothing to disclose. Dr. Wall has nothing to disclose. Mr. Pause has nothing to disclose. Gaurava Agarwal has nothing to disclose. Dr. Bonakdarpour has nothing to disclose.

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Publicly Available
Clinically Designed Improvisatory Music Interventions for Well-Being and Burnout Prevention for Neurology, Psychiatry, and Other Health Professionals: Preliminary Findings (S11.003)
By
Takarabe, Clara; Shah, Rajan; Walesa, Macy; Ngo, Eileen; Wall, Brian; Pause, Logan; Agarwal, Gaurava; Bonakdarpour, Borna
Source:
Neurology

Key points

• Self-perceived wellness is known to worsen during medical education and training.
• Mitigation strategies should have a bifocal approach addressing individual as well as system-level factors.
• Organizations can better support well-being for their workforce by having leadership structure in place to drive well-being strategy and program development.
• Wellness programs need to have a multipronged strategy and should be focused on four key areas: healthy work environments, efficient processes, healthy people, and safe teams.

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Publicly Available
Clinician Well-Being: Addressing Distress and Burnout
By
MacLean, Lisa
Source:
Advances in Psychiatry and Behavioral Health

[This is an excerpt.] In 2017, my husband suffered a critical illness. He is also a physician, and during the course of his short stay at our local hospital, the doctors caring for him—his colleagues—were distant and impassive in the face of his extremis. They delayed his transfer, despite my urgent requests, until his next option for treatment was extracorporeal membrane oxygenation, a therapy not offered at the small facility. They were caring people and not reckless physicians, so their stonewalling and what felt like brinkmanship with my husband’s life seemed out of character. But their inaction stuck with me because of how unsettling and inexplicable it was, given what I knew of them, and of medicine. If asked what was wrong, they might have said they were burned out, because there was no other language for their experience at the time. But to me, their struggle seemed different. It seemed like their hands were tied, as though without accurate language, they were resigned to a situation they couldn’t articulate and therefore could not solve. [To read more, click View Resource.]

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Publicly Available
Clinicians in Distress
By
Dean, W.
Source:
American Federation of Teachers

[This is an excerpt.] The incidence and impact of burnout among physicians are of ever-increasing concern. Burnout is characterized by emotional exhaustion, depersonalization, and an impaired sense of personal accomplishment caused by work-related stress. The data consistently reveal that among physicians, surgeons are at a substantially increased risk of burnout. Thus, for the benefit of ourselves, our colleagues, our trainees, and our patients, it is paramount that we tackle the subject of burnout, specifically its prevention and management, with thoughtfulness and rigor. [To read more, click View Resource.]

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Publicly Available
Coaching the Coach to Reduce Burnout: Commentary on Do Resident Coaching Programs Benefit Their Coaches? Impact of a Professional Development Coaching Program on the Coaches
By
Stewart, Melissa K.; Kao, Lillian S.
Source:
World Journal of Surgery

OBJECTIVE: Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic. METHODS: This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings. FINDINGS: Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively. CONCLUSION: The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics. CLINICAL RELEVANCE: EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.

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Publicly Available
Cognitive Appraisals and Coping Strategies of Registered Nurses in the Emergency Department Combating COVID-19: A Scoping Review
By
Lin, Chia-Hung; Siao, Shu-Fen; Lin, You-Jie; Hsin, Pin-Hsien; Shelley, Mack; Lee, Yen-Han
Source:
Journal of Nursing Scholarship